Optum Real Claim Pre-Check API
With Real Claim Pre-Check API, providers can complete a series of validation steps to improve the efficiency of claim processing and reduce the risk of invalid claims before a claim is submitted.
Through a single, centralized API, providers can validate claim data directly within their existing workflow, including:
- X12 claim validation (HIPAA)
- Membership and coverage eligibility for the date of service
- Coordination of Benefits (COB) including primacy and coverage details for patient
- Prior Authorization (PA) requirements and status
- Adherence to payment and medical policies
| Release Notes | Resources |
|---|---|
| View Release Notes for more information about the history of programmatic updates for Optum Real APIs. | Check out our API Setup , Real Claim Pre-Check API User Guide and Technical Reference Guide for more information on API integration. |