Customize
Using our Knowledge Packs, our representatives can tailor your Professional Claims error checks and validations to the needs of your medical team.
Specialize
If you need a powerful general billing capability, or you specialize in Medicare, ambulance place of service, dialysis, you can order a Knowledge Pack that matches specific claims requirements.
Developer resources
Integrated Rules Professional 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: Do you have a sandbox that I can test before signing a contract?
A: 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.
Q: What is the biggest value-add from using this API?
A: For all Integrated Rules Professional API applications, be familiar with the term edits, which has a specific meaning in this context.
Payers control their own claims edit specifications. Edit specifications govern how medical practices must submit correct claims information for payer processing and approvals or disapprovals. Claims edits can change at any time, and notifications of these changes may or may not reach you before you submit a professional claim, much less be integrated into your claims submission software.
Because of this likelihood, you may encounter unexpected errors and incur unexpected delays when filing claims, even when you think your software is up to date and hence your claims are accurate.
These issues can occur at any time. Some medical practices may subscribe to continuous payer updates and submission edits, and receive their notifications from the payer. Others may not do so, finding the costs prohibitive. The Integrated Rules Professional services team monitors regulatory requirements from Medicare and from industry organizations of many different types, and builds the Integrated Rules Knowledge Packs based upon the medical disciplines and the rules/edits that apply to them. Using the Knowledge Packs that you order as a match for your business, we tailor your Integrated Rules API to your specific needs.
Q: What's the difference between this API and the regular Professional Claims API?
A: The standard Professional Claims API uses a separate set of rules and logic for scrubbing a professional claim, and is applicable across a range of professional specialties. The Integrated Rules Professional API provides greater specialization through the selection of Knowledge Packs to support your provider's medical specialties.
Your account is almost complete! To quickly access your account,