API Data Dictionary

The attached spreadsheet serves as a comprehensive data dictionary for the API. It includes detailed documentation of the following components:

Request Elements-Describes the input parameters required for the API or data query.
Includes field names, data types, required/optional status, and descriptions.

Response Elements-Lists the fields returned in the response payload.
Includes field names, data types, possible values, and descriptions.

Query Samples-Provides graphql example queries for each operation to demonstrate how to interact with the API.
Useful for developers and testers to understand expected formats and usage patterns.

Error Codes-Documents the possible error codes returned.Includes code values, error messages, and explanations to aid in troubleshooting.

Overview

The Real Prior Auth/Referral Actions API streamlines the process of submitting and managing prior authorizations and referrals before care is delivered. It helps reduce denials and unexpected bills by enabling providers to submit requests and track statuses in real time. This API ensures that all necessary approvals are obtained prior to services being rendered, improving efficiency and compliance. It also enables users to quickly search for the provider and get the provider details. By centralizing these actions, it minimizes administrative burden and enhances transparency for both providers and members. Overall, it delivers a flexible and reliable solution for managing pre-service requirements.

Key Capabilities

• Prior Auth Submission – Submit a pre-authorization request before services are rendered. (coming soon)
• Referral Submission – Facilitate the submission of referral requests for required services.
• Prior Auth Status – Retrieve the status of a submitted prior authorization request.
• Referral Status – Retrieve the status of a submitted referral request.
• Search Provider - Search for the provider and get the provider details.
• Prior Auth Attachments - Ability to submit documents to support a Prior Auth. (coming soon)

Test API

1. Use token generated using client ID and secret key for sandbox or production.
2. Download API specs from overview page - every API overview section provides links to download the file in a JSON format, which generates our documentation for developers to use.
3. Hit API endpoint through the following options:
   -Use Try It page to request complete API response or customize response for
   Sandbox API endpoint only.

OR
-Use Postman to request complete API response or customize response for Sandbox and
Production API endpoint.

NOTE: Do not submit PHI or PII data in the Try It page.

Sandbox use for live and mock data testing

1. Customers must have purchased an API with status “subscribed” in the AI Marketplace account, please work with API consultant to associate provider TIN(s) before sending live data to sandbox environment.
2. Customers must use their sandbox credentials to send live data to the sandbox environment for the API purchased.
   At this point, responses will be based on the live data submitted to the sandbox environment as opposed to mock data preloaded to the sandbox environment.
3. The customer will retain the ability to query mock responses from a sandbox environment by using an optional request header called “environment”. By placing the value “sandbox" in the optional header, the request return mock responses.
   NOTE: Do not submit PHI or PII data in the TRY IT page.

API Endpoint

Notes:
DO NOT perform load testing or production data testing in the sandbox environment. Please use the sandbox ONLY to view sample API responses to HTTP requests using our predefined values and to familiarize yourself with our APIs.

To perform load testing and production data testing, we recommend using our APIs in the production environment.

API health check

The health check endpoint checks the operating status of our API. It is a ping for the API entry point to ensure the entry points are accessible. This is the first thing you can do if something goes wrong.

• To run the health check of an Optum Real API - the Real Pre Service Eligibility API, go to
  Healthcheck If the API engine is working correctly and if the entry points are accessible, the API operating status response shows "OK."

NOTE If you receive a response other than 200 OK, the health check failed.
Please submit a service ticket with Optum.