Claim Validation

post

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

📘
NOTE
For attendingProvider, do not send the organizationName.

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.

Query Params

USERNAME

string

required

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 Validation

📘
NOTE

❗️
IMPORTANT

📘NOTE

❗️IMPORTANT

200OK

📘
NOTE

❗️
IMPORTANT