It can receive and return client data in either X12-278 or JSON over HTTPS. We’ll return the data in the same format the client used to send the transaction.
Our system is connected to EDI/direct payers and a wide range of web portal payers. The API is also responsible for payer-specific requests and request transformation.
We’re connected to all major UM vendors for radiology services in addition to most of the major medical connections.
We’ll return a variety of 278 certification action codes that represent the payer’s authorization status, which users can then interpret to understand the status. These codes represent common statuses, such as approved, partially approved, pending and denied, plus other error messages.
A: Our team can create an account for you to test the API in our sandbox. We have a few pre-written responses, that are not from payers, so you can see how the responses appear.
A: You’ll need to send the data according to our API contract and handle the responding data. Our implementation team will need to work with your client to map their payer IDs to our system's payer ID.
A: No, the Inquiry API checks synchronously upon a request. It’s in the 2025 roadmap to automatically check the status daily until the authorization date of service, or until the authorization has reached its terminal status (approved, denied).
Easily connect your payers and providers through the Optum Intelligent Health Care Network™, the largest in the U.S. Our APIs handle complex transactions behind-the-scenes and make JSON data human-readable. Plus, check claim status across hundreds of payers in real time.
This API manages the X12 standards behind the scenes and gives you instant access to medical subscriber or dependent plan membership, copays, coinsurances, deductibles and more in a simple, human-readable format.
This solution builds on the existing 270/271 JSON-based API, delivering advanced features that boost response accuracy and quality. Our customer-specific rules engine uses submitter data to refine transactions in real time, eliminating manual tracking and saving considerable time.
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