User Guide

The Optum Real Claim Pre-Check API is designed to help your practice catch potential issues with claims before they are submitted. By running a check after a patient visit, you can identify and address common errors and avoid delays in reimbursement.

When to use it:

• After seeing a patient, before submitting a claim to the payer
• As part of your billing workflow to ensure claims are clean and complete

How it helps:

• Flags missing or incorrect information in the claim
• Identifies issues with member data or system availability
• Helps reduce claim denials and rework, saving time and effort

What you’ll see:

After submitting a claim through the Optum Real Claim Pre-Check API, you’ll receive a response that confirms if the claim is complete and accurate or if there is an issue that should be addressed before submission. The response will include a code and a brief explanation to help you understand what (if anything) needs to be updated.

This might include things like:

• Missing or incorrect information (e.g., tax ID number, member details or service data)
• Issues with member eligibility or plan compatibility
• Confirmation that the claim passed validation

These messages are designed to help you quickly identify and resolve issues, so your claims are more likely to be accepted the first time.