Optum Real Claim Pre-Check API
With Optum 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
Supported Payer IDs for UnitedHealthcare
| API | Supported Payer IDs |
|---|---|
| Real Claim Pre-Check | All Modules: 00773, 03432, 06111, 25463, 36273, 37602, 39026, 41161, 41194, 52461, 65088, 74227, 76342, 76343, 78857, 81400 , 86047, 86050, 87726, 88337, 94265, 95378, 95467, 95958, 96385, USN01, UHNDC |
| Release Notes | Resources |
|---|---|
| View Release Notes for more information about the history of programmatic updates for Optum Real APIs | API Setup , Optum Real pre-Service Eligibility API User Guide and Technical Reference Guide for how to integrate with Optum Real APIs. |