Claim Submission

post

https://sandbox-apigw.optum.com/medicalnetwork/institutionalclaims/v1/submission

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NOTE
You can ignore the taxId field in the receiver object below. This does not need to be sent, and it does not impact anything if sent. This field is overridden within the clearinghouse.

To include Primary Claim information for Secondary Claim in the API:

Send any payer-specific information in the otherPayerName object.
Use otherSubscriberInformation to convey details for the member specifically.

For more information about primary, secondary, and tertiary claims, Institutional Claims API JSON-to-EDI contents.

❗️
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

controlNumber

string

required

Interchange Control Number ISA13 GS06 ST02

tradingPartnerServiceId

string

Loop: 2010BB NM109 where NM108=PI

submitter

object

required

Loop: 1000A

receiver

object

required

Loop: 1000B

subscriber

object

required

Loop: 2000B, used in 2000C when dependent not present

dependent

object

Loop: 2000B and 2000C

providers

array of objects

length between 1 and 2147483647

Another way to set billing, referring, rendering and attending provider, this will overwrite anything you send in billing, referring, rendering, attending. Loop: 2000A,2310F,2310D,2310A

providers

providerType

string

enum

required

Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider

Allowed:

npi

string

Segment: NM1, Element:NM109 where NM108=XX

secondaryIdentificationQualifierCode

string

enum

Segment: REF, Element: REF01, Notes: Allowed Values are: '0B' State License Number, '1G' Provider UPIN Number, 'G2' Provider Commercial Number,'LU' Location Number

Allowed:

secondaryIdentifier

string

Segment: REF, Element: REF02

employerId

string

Segment: REF, Element: REF02 where REF01=EI

commercialNumber

string

deprecated

Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

locationNumber

string

deprecated

Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

stateLicenseNumber

string

deprecated

Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

providerUpinNumber

string

deprecated

Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider, otherPayerRenderingProvider and otherPayerReferringProvider.

taxonomyCode

string

Segment: PRV03, Element: PRV03 where PRV02=PXC

firstName

string

Segment: NM1, Element: NM104

lastName

string

Segment: NM1, Element: NM103

middleName

string

Segment: NM1, Element: NM105

suffix

string

Segment: NM1, Element: NM107

organizationName

string

Segment: NM1, Element:NM103

address

object

N3 and N4

contactInformation

object

PER

billingPayToPlanName

object

Loop: 2010AC

billingPayToAddressName

object

Loop: 2010AB Billing Provider Pay To Address Name

operatingPhysician

object

Loop 2310B

otherOperatingPhysician

object

LOOP: 2310C

claimInformation

object

required

Loop: 2000B, 2000C and 2300

payerAddress

object

N3 and N4

usageIndicator

string

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

billing

object

required

Loop: 2000A

referring

object

Loop: 2310F

rendering

object

Loop: 2310D

attending

object

Loop: 2310A

tradingPartnerName

string

Loop: 2010BB NM103 where NM101=PR and NM102=2. Notes: Required

Claim Submission

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NOTE

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IMPORTANT

📘NOTE

❗️IMPORTANT

200OK

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NOTE

❗️
IMPORTANT