Overview

Optum Real Pre-Service Eligibility API

With Real Pre-Service Eligibility API, providers can submit real-time eligibility inquiries to payers before a patient’s scheduled visit, helping to streamline the process. This centralized API gives you access to patient eligibility information
across multiple payers, all within your existing EHR system..

Through a single, centralized API, providers can access eligibility data across multiple payers directly within their existing workflow, including:

• Eligibility information including patient demographic information, plan-level cost shares, plan coverage details and insurance details
• Coordination of benefits including primacy and coverage details for each payer plan
• Image of a patient’s insurance ID card
• Provider in- and out-of-network status

Supported Payer IDs