{"openapi":"3.0.0","info":{"version":"1.0.0","description":"API for RTS Payer Dental Claim Actions","title":"Real Dental Claim Submission API"},"servers":[{"url":"https://sandbox-apigw.optum.com"}],"paths":{"/py/oihub/claim/dnt/submit/v1/graphql":{"post":{"parameters":[{"name":"providerTaxId","in":"header","description":"Provider Tax ID","required":false,"schema":{"type":"string","example":"123456789"}},{"name":"x-optum-consumer-correlation-id","in":"header","description":"Correlation ID can be used to trigger the Mock API call for dental claim submission. Use \"test_\" in order to hit the Mock flow. Example correlation ID : test_dnt-claim-submission-200_success","required":false,"schema":{"type":"string","example":"4d4a8964-e5fa-42dc-a37d-12345789"}}],"requestBody":{"content":{"application/json":{"schema":{"description":"GraphQL request with query and variables for Dental Claim Submission","type":"object","required":["query","variables"],"properties":{"query":{"type":"string","description":"GraphQL mutation query string","example":"mutation claimActions($input: ClaimSubmissionInput!) { claimSubmission(input: $input) { transactionId x12Response277CA message statusCode } }"},"variables":{"type":"object","description":"Variables for the GraphQL query","required":["input"],"properties":{"input":{"description":"Claim submission input data","$ref":"#/components/schemas/ClaimSubmissionInput"}}}}},"examples":{"SubmitDentalClaim":{"summary":"Submit Dental Claim Request","value":{"query":"mutation claimActions($input: ClaimSubmissionInput!) { claimSubmission(input: $input) { transactionId x12Response277CA message statusCode } }","variables":{"input":{"x12RequestData":"ISA*00*          *00*          *ZZ*DENTAL123      *ZZ*PAYER456       *260113*1430*^*00501*000000001*0*P*:~GS*HC*DENTAL123*PAYER456*20260113*1430*1*X*005010X224A2~ST*837*0001*005010X224A2~BHT*0019*00*D001*20260113*1430*CH~NM1*41*2*ABC DENTAL*****XX*1234567890~PER*IC*CONTACT*TE*5551234567~NM1*40*2*DELTA DENTAL*****46*98765~HL*1**20*1~PRV*BI*PXC*1223G0001X~NM1*85*2*ABC DENTAL*****XX*1234567890~N3*555 DENTAL DR~N4*CITY*ST*12345~REF*EI*123456789~HL*2*1*22*0~SBR*P*18*******CI~NM1*IL*1*SMITH*JANE****MI*ABC123456~N3*456 ELM ST~N4*CITY*ST*12345~DMG*D8*19800101*F~NM1*PR*2*DELTA DENTAL*****PI*98765~CLM*D001*150***11:B:1*Y*A*Y*Y~DTP*431*D8*20260110~REF*D9*REF789~HI*ABK:K0210~LX*1~SV3*AD:D0120*150**1~TOO*JP*4~DTP*472*D8*20260110~SE*23*0001~GE*1*1~IEA*1*000000001~","payerId":"88848"}}}}}}},"required":true},"tags":["Dental Claim Actions"],"responses":{"200":{"content":{"application/json":{"examples":{"SubmitDentalClaim":{"summary":"Dental Claim Submission Response","value":{"transactionId":"8841512345678901","x12Response277CA":"ISA*00*          *00*          *ZZ*87726          *ZZ*B00099999805   *250911*1927*^*00501*000000000*0*P*:~GS....~GE*1*0~IEA*1*000000000~","message":"Claim submitted successfully. Refer 277CA for validation outcomes.","statusCode":"000"}}},"schema":{"type":"object","properties":{"data":{"type":"object","properties":{"claimSubmissionResponse":{"description":"","$ref":"#/components/schemas/ClaimSubmissionResponse"}}},"errors":{"items":{"type":"object","properties":{"code":{"type":"string","description":"Error code identifying the specific error"},"description":{"type":"string","description":"Detailed error message"}}},"description":"List of errors that occurred during Dental Claim Actions","type":"array"}}}}},"description":"**SubmitDentalClaim**\n\n\n\n**Success Response:**\n\n* 000 - Dental claim submitted successfully. Refer 277CA for validation outcomes.\n\n\n\n**Error Codes (Global Codes):**\n\n* REQ_401 - Unauthorized: Missing/invalid/expired credentials or token\n\n* REQ_422 - Validation failed: Request is syntactically valid but fails semantic validation\n\n* REQ_500 - Internal server error: Unexpected error\n\n* REQ_503 - Service unavailable: Downstream service is currently unavailable\n\n* REQ_504 - Gateway timeout: Upstream dependency timed out\n\n* GTW_06 - TA1 Rejection: TA1 acknowledgment indicates envelope failure\n\n* GTW_08 - Unknown Document: Gateway does not recognize document structure\n\n* GTW_11 - Service Failure: General processing error at the downstream service\n\n* GTW_12 - Downstream Timeout: Payer system failed to respond within SLA\n\n* GTW_13 - Persistence Error: Internal storage failure at the gateway\n\n* GTW_14 - Ack Failure: Failure generating downstream 999/277 files\n\n* GTW_15 - Config Error: Downstream environment configuration mismatch\n\n* EDI_200 - Wrong Claim Type: Expected 837D (Dental)\n\n* EDI_203 - Batch Not Allowed: Multiple ST-SE segments detected. Single-claim submissions only\n\n* EDI_206 - Invalid segment: One or more segments are invalid, out of order, or not allowed\n"},"401":{"content":{"application/json":{"example":{"statusCode":401,"message":"Unauthorized"}}},"description":"Unauthorized"},"500":{"content":{"application/json":{"example":{"statusCode":500,"message":"Internal server error"}}},"description":"Internal Server Error"}},"description":"The Dental Claim Action API facilitates dental claim submission in X12 format and returns responses in the 277CA format. It provides a flexible GraphQL endpoint to streamline end-to-end dental claim action processing. Below operation is supported: <strong>SubmitDentalClaim:</strong> Validates if the dental claim submitted is eligible for claim submission and upon validation if the claim is eligible for submission, claim will be submitted.","summary":"Dental Claim Actions API","operationId":"dntClaimActions"}},"/py/oihub/claim/dnt/submit/v1/health-check":{"get":{"responses":{"200":{"description":"Service is healthy"},"500":{"description":"Service is unhealthy"}},"operationId":"healthCheck","tags":["HealthCheck"],"summary":"Health Check Endpoint"}}},"components":{"securitySchemes":{"gateway":{"type":"http","scheme":"bearer","bearerFormat":"JWT"},"bearerAuth":{"type":"http","scheme":"bearer","bearerFormat":"JWT","description":"Enter a Bearer access token."}},"schemas":{"ClaimSubmissionInput":{"type":"object","description":"ClaimSubmissionInput","properties":{"x12RequestData":{"example":"ISA*00*          *00*          *ZZ*SENDER ID       *ZZ*RECEIVER ID    *231012*1200*U*00501*000000001*0*P*:~ GS*HP*SENDERAPP*RECEIVERAPP*20231012*1200*000000001*X*005010X222A1~ ST*837*0001*005010X222A1~ [... BHT, HL, PRV, N1, N3, N4, CLM, CAS, PLB, HI, DMG, and other 837 segments...] SE*32*0001~ GE*1*000000001~ IEA*1*000000001~","description":"EDI837 X12 formatted claim data","type":"string"},"payerId":{"example":"88848","description":"payer ID","type":"string"}}},"ClaimSubmissionResponse":{"type":"object","description":"ClaimSubmissionResponse","properties":{"transactionId":{"example":"8841512345678901","description":"unique transactionID created by the payer for the claim submission request.","type":"string"},"x12Response277CA":{"example":"ISA*00*          *00*          *ZZ*87726          *ZZ*B00099999805   *250911*1927*^*00501*000000000*0*P*:~GS....~GE*1*0~IEA*1*000000000~","description":"edi x12-277 claim acknowledgement.","type":"string"},"message":{"example":"Claim submitted successfully. Refer 277CA for validation outcomes.","description":"Message describing the final outcome of the claim submission process.","type":"string"},"statusCode":{"example":"000","description":"status code for the submission process.","type":"string"}}}}},"security":[{"bearerAuth":[]}],"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}