Both JSON and EDI-X12 formats available
For those unfamiliar with the structure of X12-278, requests can be submitted in JSON format. The payer data will be returned in both JSON and X12-278 formats.
EDI and portal payer connections available
The system is connected to EDI/direct payers and web portal payers. The API handles payer-specific requests and request transformations.
UM vendors available for authorization inquiries
We’re connected to all major UM vendors for radiology services in addition to most of the major medical connections.
Developer resources
Prior Authorization Submission API
Q: Can the Prior Authorization API submit clinical questionnaires or attach clinical notes?
A: These features are coming soon. We’d love to discuss collaboration with you for research purposes — reach out if you’re interested.
Q: Which payers are you connected with?
A: We have a few EDI payers for submitting authorizations and numerous web portal sites where we can quickly establish connections using your test data. Please contact our sales team to discuss payer connections.
Q: What is involved to use the API once we get access?
A: Before you start using this API, you’ll need to:
- Get familiar with the API contract requests and responses
- Work with our implementation team to map your payer IDs to ours
- Integrate our APIs into your programs
Q: How can I test this in the sandbox?
A: Our team can create a free account for you to test the API in our sandbox. You’ll receive several pre-written responses that are not from payers. This will help you get familiar with the required fields in the submission API.
Recommended products
Revenue Cycle APIs
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.
Prior Authorization Inquiry API
The Prior Authorization Inquiry API checks for authorization status from payers in real time. It connects EDI, web portal payers and utilization management (UM) vendors for authorization inquiries. It can receive your request in JSON or EDI-X12 format and return it in the same format.
Eligibility API
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.
Marketplace updates
Subscribe to The Spark
We're adding new products and services to rapidly expand our marketplace and the potential is huge. Be an early adopter and stay ahead of the trend with our bi-weekly e-updates.
Your account is almost complete! To quickly access your account,