User Guide

The Optum Real Pre-Service Eligibility API helps your practice determine whether a patient is eligible for services before their appointment. This tool is designed to reduce administrative burden and improve scheduling efficiency by giving you real-time access to eligibility information.

When to use it:

• Confirm eligibility after an appointment is scheduled to ensure coverage before the patient arrives
• Check eligibility during scheduling to avoid booking patients without coverage, saving time for staff and patients

How it helps:

• Reduces last-minute cancellations due to coverage issues
• Helps ensure smoother check-in and billing processes
• Minimizes time spent on follow-up calls or rescheduling

What you’ll see:

• A simple response indicating whether the patient is eligible
• Additional details (if applicable) about coverage limitations or requirements

How it’s different:

• View the member’s ID card, including front and back
• Identify provider network status in real time
• Access enhanced coordination of benefits using payer rosters instead of limited payer-set flags