Overview

Optum Real Patient Benefit Check API

With Real Patient Benefit Check API, providers can validate patient benefits as well as prior authorization and referral requirements before care is delivered. This centralized API allows you to reduce denials and give patients clear answers about what’s covered and what they’ll owe before they receive care, reducing surprise bills and improving patient satisfaction.

Through a single, centralized API, providers can check patient's:

• Prior authorization requirements and if one already exists for specific service
• Referral requirements and if one already exists for specific service
• Benefits covered by CPT code including limits, restrictions and exceptions*
• Cost share details for in-network and out-of-network services*

* Not currently available. Planned for future release.

Supported Payer IDs