Convenient
The ASC X12N Health Care Claim: Institutional (837i) transaction enables healthcare providers to submit healthcare claims for a service or encounter.
Thorough
A healthcare claim includes patient information, related diagnoses, procedures performed or services provided and any related charges.
Accessible
This API also translates standard X12 EDI 837i transactions to JSON so that it is more accessible to claim readers and developers.
Developer resources
Institutional Claims API
Brochure
Gain connectivity and flexibility with electronic claims transactions
While many service providers lack the connectivity, scale, support, stability and information security standards to adequately meet providers’ needs, we position providers to meet the demands of today’s and tomorrow’s environment.
Q: What's the difference between an Institutional claim and a Professional claim?
A: Institutional billings use the 837i transaction. Professional billing typically uses the 837p transaction (or the CMS-1500 form in hard copy). We support both types of electronic claims and transactions in separate API products.
Institutional billing also sometimes encompasses collections, while Professional claims and billing typically doesn't. Professional billing controls the billing of claims generated for work performed by physicians, suppliers and other non-institutional providers for both outpatient and inpatient services. People handling Professional claims typically understand both billing and insurance coding. Our APIs help support and automate insurance coding.
Q: How do Institutional Claims work for Medicare?
A: Medicare payers accept claims only for subscribers. If you want to submit a dependent claim with a Medicare payer, submit the dependent as a subscriber in the claim request.
Q: Do you have a sandbox that I can test before signing a contract?
Yes, you can use our sandbox environment before signing a contract. The login requires a separate set of credentials that you can get from your Optum representative. After receiving your client_id and client_secret for our sandbox environment, you can test the API in our interactive documentation, use an application like Postman, or test APIs using your own development console.
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