Our APIs enable vendors to accelerate the time to market and focus on rapid service expansion, with key solutions delivered in an easy to use, plug-and-play format. Managing the large influx of patients, and their associated insurance claims, also requires a streamlined intake process.
Security and Authorization v2
Optum uses OAuth2 to create a secure connection with our API users, which requires a bearer authorization token (sandbox-apigw.optum.com/apip/auth/v2/token/ endpoint) to obtain access.
Medical Network APIs
Our APIs take standard X12 transactions and translate them to JSON so that they are more accessible to developers and easily integrated into users' applications.
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The Eligibility API (X12 EDI 270/271) gives providers complete patient insurance benefit profiles for appropriate care delivery, efficient, and accurate reimbursement.
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The Professional Claims API (837P) and the Institutional Claims API (837I) allow healthcare providers and institutions to submit healthcare claims for a service or encounter.
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The Institutional Claims API (837i) transaction enables institutional healthcare providers to submit healthcare claims for a service or encounter.
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The Claim Status API (276/277) is used by the submitter of a medical claim to determine the status of any previously submitted Institutional or Professional claims.
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The Claim Responses and Reports (ERA) API provides a direct connection to your mailbox where payers will send their responses and reports to your claims. It enables you to download all claims information from your payer, regardless of claim type. We provide this feature at no cost to you.
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The Dental Attachments API provides the capability to send attachments data (including but not limited to X-Rays, EOBs, Charts, and so on), to Optum Dental electronically. This data will include claim demographic (payer, provider, patient, and service) details, and attachments related information.
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The Attachment Submission API (X12 EDI 275) enables healthcare providers to submit healthcare claim attachments for a service or encounter. You can consider this API as an important addition to Professional Claims and Institutional Claims.
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The Attachment Status API enables healthcare providers to get the status of healthcare claim file attachments for a service or encounter. It is particularly helpful for users keeping track of attachments for complex claims. It even provides support for payers that do not offer electronic attachment capabilities and require only fax or mail for attachment submissions.
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The Attachment Retrieval API lets you search for and download the attachment documents for payers.
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The Integrated Rules Professional (837P) and Integrated Rules Institutional (837I) APIs enable you to perform medical specialty-based claim scrubbing and fix any possible errors before sending a Professional Claims or Institutional Claims to the payer.