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Claim Submission

post
https://sandbox-apigw.optum.com/medicalnetwork/professionalclaims/v3/submission
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NOTE

Setting of Providers is deprecated, please set all Providers individually by its type.

📘

NOTE

Under the submitter object, either organizationName, lastName, or firstName attribute is required.

❗️

IMPORTANT

Please note that the request requires you to provide all the required field values. These required values are GREYED out, which are pre-populated example values and can be selected to view the canned response. To view the required fields, expand the + symbol (indicated by the variables field below. For more information, please refer to the JSON-to-EDI API Contents section.

Body Params
string
required

Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number

string

Loop: 2010BB Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI = Payer Identification

submitter
object
required

Loop: 1000A

receiver
object
required

Loop: 1000B

subscriber
object
required

Loop: 2000B

dependent
object

LOOP 2000C

providers
array of objects
length between 1 and 2147483647
deprecated

setting providers deprecated, please set all providers individually by it's type.

providers
string
required
string

NM109, Notes: National Provider Identifier

string

REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine numbers with no separators

string

REF02 when REF01=EI, Notes: The Employer Identification Number must be a string of exactly nine numbers with no separators

string

REF02 when REF01=G2

string

REF02 when REF01=LU

string

LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U

string

LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI

string

Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY

string

Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association of Insurance Commissioners (NAIC) Code

string

REF02 when REF01=0B

string

REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999

string

PRV03

string

NM104

string

NM103

string

NM105

string

NM107

string

NM103

address
object

N3 and N4

contactInformation
object

PER

claimInformation
object
required

Loop2300

payToAddress
object

N3 and N4

payToPlan
object

2010AC

payerAddress
object

N3 and N4

string

Interchange Usage Indicator ISA15; T-Test Data, P-Production Data

billing
object
required

Loop: 2000A

referring
object

Loop: 2420F

rendering
object

Loop: 2420A

ordering
object
deprecated

Loop: 2420E, Setting ProviderType equal to OrderingProvider is deprecated, please use ClaimInformation.serviceLines.orderingProvider

supervising
object

Loop: 2420D

string

Loop 2010BB NM103

Headers
string
string
required

Bearer Your-Access-Token
Example: Bearer eyJraWQiOiIxIiwid…

Response

Updated about 2 months ago

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Response
Click Try It! to start a request and see the response here! Or choose an example:
application/json

Updated about 2 months ago