{"openapi":"3.0.3","info":{"title":"Attachments Submission Prior Authorization API","description":"API for submitting 275X211 prior authorization attachments to trading partners.","version":"v1"},"servers":[{"url":"https://sandbox-apigw.optum.com/medicalnetwork/attachments/submission/v1","description":"Default server"}],"tags":[{"name":"Health Check","description":"Health Check"},{"name":"Attachment Submission","description":"Attachment Submission"}],"paths":{"/healthcheck":{"get":{"tags":["Health Check"],"summary":"Health Check","operationId":"healthCheck","description":"Returns the health status of the service. Called by the AWS load balancer to verify the service is alive.","security":[],"responses":{"200":{"description":"Service is healthy","content":{"application/json":{"schema":{"type":"object","properties":{"status":{"type":"string","example":"Healthy"}}},"example":{"status":"Healthy"}}}}}}},"/uploads/prior-auth":{"post":{"tags":["Attachment Submission"],"summary":"Attachment Submission Prior Auth","operationId":"updatePriorAuth","description":"Submit a 275X211 JSON payload and associated file(s) for prior authorization attachment submission. The request field is a JSON string conforming to the RequestPriorAuth schema.","parameters":[{"name":"validateSubmitter","in":"header","required":false,"schema":{"type":"boolean","default":false},"description":"When true, performs submitter validation lookup before processing."}],"requestBody":{"required":true,"content":{"multipart/form-data":{"schema":{"type":"object","required":["files","request"],"properties":{"files":{"type":"array","items":{"type":"string","format":"binary"},"description":"One or more attachment files to upload. Each file name must match the name in attachmentDetails."},"request":{"type":"string","description":"JSON string conforming to the RequestPriorAuth schema. The default value below is a complete, ready-to-send example to make testing easier.","default":"{\"controlNumber\":\"123459998\",\"purposeCode\":\"11\",\"informationSource\":{\"entityIdentifierCode\":\"1P\",\"lastName\":\"Smith\",\"firstName\":\"John\",\"npin\":\"1942788757\",\"contactInformation\":{\"name\":\"Johnone Doeone\",\"phoneNumber\":\"0000000000\",\"phoneExtension\":\"101\"},\"providerSecondaryInformation\":{\"stateLicenseNumber\":\"SL123456\"}},\"informationReceiver\":{\"organizationName\":\"XYZ Insurance Company\",\"planId\":\"PLAN12345\",\"payerIdentification\":\"ATTP1\",\"contactInformation\":{\"name\":\"Johnone Doeone\",\"phoneNumber\":\"0000000000\"},\"providerSecondaryInformation\":{\"medicareProviderNumber\":\"MCARE12345\"}},\"patient\":{\"entityIdentifierCode\":\"IL\",\"firstName\":\"Johnone\",\"lastName\":\"Doeone\",\"memberId\":\"0000000002\",\"patientAccountNumber\":\"ACCT987654\",\"patientEventTrackingNumber\":\"TRK2024001\",\"contactInformation\":{\"name\":\"Johnone Doeone\",\"phoneNumber\":\"0000000000\"}},\"serviceReviewInformation\":{\"serviceLines\":[{\"attachmentControlNumber\":\"ATT123456789\",\"submissionDate\":\"20240414\",\"diagnosisCode\":\"M54.5\",\"procedureCode\":\"99213\",\"procedureCodeQualifier\":\"FO\",\"serviceTraceNumber\":\"SVC20240414001\",\"statusInformation\":{\"statusCategoryCode\":\"A1\",\"loincCode\":\"11488-4\"},\"attachmentDetails\":{\"name\":\"test_image.jpg\",\"attachmentInformationFormatCode\":\"MB\",\"binaryDataLength\":\"2048\"}}]}}","example":"{\"controlNumber\":\"123459998\",\"purposeCode\":\"11\",\"informationSource\":{\"entityIdentifierCode\":\"1P\",\"lastName\":\"Smith\",\"firstName\":\"John\",\"npin\":\"1942788757\",\"contactInformation\":{\"name\":\"Johnone Doeone\",\"phoneNumber\":\"0000000000\",\"phoneExtension\":\"101\"},\"providerSecondaryInformation\":{\"stateLicenseNumber\":\"SL123456\"}},\"informationReceiver\":{\"organizationName\":\"XYZ Insurance Company\",\"planId\":\"PLAN12345\",\"payerIdentification\":\"ATTP1\",\"contactInformation\":{\"name\":\"Johnone Doeone\",\"phoneNumber\":\"0000000000\"},\"providerSecondaryInformation\":{\"medicareProviderNumber\":\"MCARE12345\"}},\"patient\":{\"entityIdentifierCode\":\"IL\",\"firstName\":\"Johnone\",\"lastName\":\"Doeone\",\"memberId\":\"0000000002\",\"patientAccountNumber\":\"ACCT987654\",\"patientEventTrackingNumber\":\"TRK2024001\",\"contactInformation\":{\"name\":\"Johnone Doeone\",\"phoneNumber\":\"0000000000\"}},\"serviceReviewInformation\":{\"serviceLines\":[{\"attachmentControlNumber\":\"ATT123456789\",\"submissionDate\":\"20240414\",\"diagnosisCode\":\"M54.5\",\"procedureCode\":\"99213\",\"procedureCodeQualifier\":\"FO\",\"serviceTraceNumber\":\"SVC20240414001\",\"statusInformation\":{\"statusCategoryCode\":\"A1\",\"loincCode\":\"11488-4\"},\"attachmentDetails\":{\"name\":\"test_image.jpg\",\"attachmentInformationFormatCode\":\"MB\",\"binaryDataLength\":\"2048\"}}]}}"}}},"encoding":{"files":{"contentType":"application/octet-stream"},"request":{"contentType":"application/json"}}}}},"responses":{"207":{"description":"Multi-status response indicating the result of the attachment submission.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Response"}}}},"400":{"description":"Bad Request - validation failure or malformed input.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Response"}}}},"500":{"description":"Internal Server Error.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Response"}}}}}}}},"components":{"schemas":{"RequestPriorAuth":{"type":"object","description":"275 X211 Request - Additional Information to Support a Health Care Services Review. This schema documents the structure of the JSON string sent in the request form field.","required":["controlNumber","informationSource","informationReceiver","patient","serviceReviewInformation"],"properties":{"controlNumber":{"type":"string","minLength":4,"maxLength":9,"default":"123459998","example":"123459998","description":"ST02 - Transaction Set Control Number"},"purposeCode":{"type":"string","default":"11","example":"11","description":"BGN02 - Transaction Set Purpose Code"},"informationSource":{"$ref":"#/components/schemas/InformationSource"},"informationReceiver":{"$ref":"#/components/schemas/InformationReceiver"},"patient":{"$ref":"#/components/schemas/Patient"},"serviceReviewInformation":{"$ref":"#/components/schemas/ServiceReviewInformation"}}},"InformationSource":{"type":"object","description":"Information Source; Loop 1000A - Entity supplying additional information","properties":{"entityIdentifierCode":{"type":"string","enum":["1P","2B","36","FA","PR","X3"],"default":"1P","example":"1P","description":"NM101 - Information Source Entity Identifier Code"},"organizationName":{"type":"string","minLength":1,"maxLength":60,"description":"NM103 when NM102 = 2; LOOP 1000A"},"lastName":{"type":"string","minLength":1,"maxLength":60,"default":"Smith","example":"Smith","description":"NM103 when NM102 = 1; LOOP 1000A"},"firstName":{"type":"string","minLength":1,"maxLength":35,"default":"John","example":"John","description":"NM104 when NM102 = 1; LOOP 1000A"},"npin":{"type":"string","minLength":2,"maxLength":80,"default":"1942788757","example":"1942788757","description":"NM109 when NM108 = XX - National Provider Identifier; LOOP 1000A"},"contactInformation":{"$ref":"#/components/schemas/ContactInformation"},"providerSecondaryInformation":{"$ref":"#/components/schemas/ProviderSecondaryInformation"}}},"InformationReceiver":{"type":"object","description":"Information Receiver; Loop 1000B - UMO/Payer receiving information","properties":{"entityIdentifierCode":{"type":"string","enum":["1P","2B","36","FA","PR","X3"],"description":"NM101 - Information Receiver Entity Identifier Code"},"organizationName":{"type":"string","minLength":1,"maxLength":60,"default":"XYZ Insurance Company","example":"XYZ Insurance Company","description":"NM103 when NM102 = 2; LOOP 1000B"},"planId":{"type":"string","minLength":2,"maxLength":80,"default":"PLAN12345","example":"PLAN12345","description":"NM109 when NM108 = PI - Plan Identifier; LOOP 1000B"},"payerIdentification":{"type":"string","minLength":2,"maxLength":80,"default":"ATTP1","example":"ATTP1","description":"NM109 when NM108 = PI - Payer Identification; LOOP 1000B"},"contactInformation":{"$ref":"#/components/schemas/ReceiverContactInformation"},"providerSecondaryInformation":{"$ref":"#/components/schemas/ProviderSecondaryInformation"}}},"Patient":{"type":"object","description":"Patient; Loop 1000C - Subject of the service review event.","required":["entityIdentifierCode","lastName"],"properties":{"entityIdentifierCode":{"type":"string","enum":["IL","QC"],"default":"IL","example":"IL","description":"NM101 - IL when subscriber is patient; QC when dependent is patient"},"firstName":{"type":"string","minLength":1,"maxLength":35,"default":"Johnone","example":"Johnone","description":"NM104 - Patient First Name"},"lastName":{"type":"string","minLength":1,"maxLength":60,"default":"Doeone","example":"Doeone","description":"NM103 - Patient Last Name"},"middleName":{"type":"string","maxLength":25,"description":"NM105 - Patient Middle Name"},"suffix":{"type":"string","maxLength":10,"description":"NM107 - Patient Name Suffix"},"memberId":{"type":"string","minLength":2,"maxLength":80,"default":"0000000002","example":"0000000002","description":"NM109 when NM108 = MI"},"hipaaIndividualId":{"type":"string","minLength":2,"maxLength":80,"description":"NM109 when NM108 = II"},"patientAccountNumber":{"type":"string","maxLength":50,"default":"ACCT987654","example":"ACCT987654","description":"REF*EJ; LOOP 1000C"},"patientEventTrackingNumber":{"type":"string","maxLength":50,"default":"TRK2024001","example":"TRK2024001","description":"REF*2I; LOOP 1000C"},"contactInformation":{"$ref":"#/components/schemas/PatientContactInformation"}}},"ServiceReviewInformation":{"type":"object","description":"Service Review detail for the 278-driven flow; Loop 2000A and subordinate loops.","required":["serviceLines"],"properties":{"serviceLines":{"type":"array","minItems":1,"items":{"$ref":"#/components/schemas/ServiceReviewLine"},"description":"One or more service review detail loops"}}},"ServiceReviewLine":{"type":"object","description":"Service Review detail; LOOP 2000A","required":["attachmentControlNumber","submissionDate","attachmentDetails"],"properties":{"attachmentControlNumber":{"type":"string","minLength":1,"maxLength":50,"default":"ATT123456789","example":"ATT123456789","description":"TRN02 - Provider or UMO Attachment Control Number; LOOP 2000A"},"submissionDate":{"type":"string","pattern":"^[0-9]{8}$","default":"20240414","example":"20240414","description":"DTP03 when DTP01 = 368 and DTP02 = D8; LOOP 2100A"},"diagnosisCode":{"type":"string","maxLength":50,"default":"M54.5","example":"M54.5","description":"REF02 when REF01 = ICD or IJ; LOOP 2000A"},"procedureCode":{"type":"string","maxLength":50,"default":"99213","example":"99213","description":"REF02 - Procedure or Revenue Code; LOOP 2000A"},"procedureCodeQualifier":{"type":"string","enum":["CPT","F1","FO","ICD","YJ","ZZ"],"default":"FO","example":"FO","description":"REF01 - Procedure or Revenue Code qualifier; LOOP 2000A"},"serviceTraceNumber":{"type":"string","maxLength":50,"default":"SVC20240414001","example":"SVC20240414001","description":"REF02 when REF01 = 6R or FJ; LOOP 2000A"},"statusInformation":{"$ref":"#/components/schemas/StatusInformation"},"attachmentDetails":{"$ref":"#/components/schemas/AttachmentDetails"}}},"StatusInformation":{"type":"object","description":"STC Status Information; LOOP 2000A. Situational for solicited responses.","required":["statusCategoryCode","loincCode"],"properties":{"statusCategoryCode":{"type":"string","default":"A1","example":"A1","description":"STC01-1 - Health Care Claim Status Category Code"},"loincCode":{"type":"string","default":"11488-4","example":"11488-4","description":"STC01-2 - Additional Information Request LOINC code"},"codeListQualifier":{"type":"string","enum":["LOI"],"description":"STC01-4 - Code List Qualifier Code"}}},"AttachmentDetails":{"type":"object","description":"Attachment details corresponding to CAT in LOOP 2100A and EFI/BIN in LOOP 2110A.","required":["name"],"properties":{"name":{"type":"string","default":"test_image.jpg","example":"test_image.jpg","description":"Attachment file name. Must match an uploaded file name."},"attachmentInformationFormatCode":{"type":"string","enum":["HL","IA","MB","TX"],"default":"MB","example":"MB","description":"CAT02 - Attachment Information Format Code"},"binaryDataLength":{"type":"string","default":"2048","example":"2048","description":"BIN01 - Binary data length in bytes; LOOP 2110A"}}},"ContactInformation":{"type":"object","description":"Information Source Contact Information; PER segment in LOOP 1000A.","properties":{"name":{"type":"string","default":"Johnone Doeone","example":"Johnone Doeone","description":"PER02; LOOP 1000A"},"phoneNumber":{"type":"string","default":"0000000000","example":"0000000000","description":"PER04 when PER03 = TE; LOOP 1000A"},"faxNumber":{"type":"string","description":"PER04 when PER03 = FX; LOOP 1000A"},"email":{"type":"string","format":"email","description":"PER04 when PER03 = EM; LOOP 1000A"},"phoneExtension":{"type":"string","default":"101","example":"101","description":"PER06 or PER08 when qualifier = EX; LOOP 1000A"}}},"ReceiverContactInformation":{"type":"object","description":"Information Receiver Contact Information; PER segment in LOOP 1000B.","properties":{"name":{"type":"string","default":"Johnone Doeone","example":"Johnone Doeone","description":"PER02; LOOP 1000B"},"phoneNumber":{"type":"string","default":"0000000000","example":"0000000000","description":"PER04 when PER03 = TE; LOOP 1000B"}}},"PatientContactInformation":{"type":"object","description":"Patient Contact Information; PER segment in LOOP 1000C.","properties":{"name":{"type":"string","default":"Johnone Doeone","example":"Johnone Doeone","description":"PER02; LOOP 1000C"},"phoneNumber":{"type":"string","default":"0000000000","example":"0000000000","description":"PER04 when PER03 = TE; LOOP 1000C"}}},"ProviderSecondaryInformation":{"type":"object","description":"Provider Secondary Information; REF segment in LOOP 1000A or 1000B.","properties":{"stateLicenseNumber":{"type":"string","default":"SL123456","example":"SL123456","description":"REF02 when REF01 = 0B - State License Number"},"medicareProviderNumber":{"type":"string","default":"MCARE12345","example":"MCARE12345","description":"REF02 when REF01 = 1C - Medicare Provider Number"},"medicaidProviderNumber":{"type":"string","description":"REF02 when REF01 = 1D - Medicaid Provider Number"},"providerUpinNumber":{"type":"string","description":"REF02 when REF01 = 1G - Provider UPIN Number"},"providerCommercialNumber":{"type":"string","description":"REF02 when REF01 = G2 - Provider Commercial Number"},"employersIdentificationNumber":{"type":"string","description":"REF02 when REF01 = EI - Employer's Identification Number"},"federalTaxpayersIdentificationNumber":{"type":"string","description":"REF02 when REF01 = TJ - Federal Taxpayer's Identification Number"}}},"Response":{"type":"object","description":"Attachment Submission Response","properties":{"status":{"type":"string","description":"Overall submission status","example":"success"},"attachmentId":{"type":"string","description":"Unique identifier assigned to the submitted attachment"},"transactionSetAcknowledgement":{"type":"string","description":"Transaction set acknowledgment code"},"implementationTransactionSetSyntaxError":{"type":"string","description":"Implementation transaction set syntax error description"},"errors":{"type":"array","items":{"$ref":"#/components/schemas/Error"}},"submittedAttachments":{"type":"array","items":{"$ref":"#/components/schemas/SubmittedStatus"}},"lastEvaluatedSubmission":{"$ref":"#/components/schemas/LastEvaluatedSubmission"}}},"Error":{"type":"object","properties":{"field":{"type":"string"},"code":{"type":"string"},"description":{"type":"string"},"followupAction":{"type":"string"},"location":{"type":"string"}}},"SubmittedStatus":{"type":"object","properties":{"transactionType":{"type":"string"},"statusDescription":{"type":"string"},"transactionSubmittedDate":{"type":"string"},"transactionStatus":{"type":"string"},"submitterId":{"type":"string"},"eventSource":{"type":"string"},"tradingPartnerServiceId":{"type":"string"},"eventTimeStamp":{"type":"string"},"transactionTraceId":{"type":"string"},"attachmentId":{"type":"string"},"userId":{"type":"string"}}},"LastEvaluatedSubmission":{"type":"object","properties":{"submitterId":{"type":"string"},"transactionSubmittedDate":{"type":"string"}}}},"securitySchemes":{"BearerAuth":{"type":"http","scheme":"bearer","bearerFormat":"JWT","description":"OAuth2 Bearer Token"}}},"security":[{"BearerAuth":[]}],"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}