Bundle

Telehealth Medical Eligibility and Claims Management Bundle

This grouping of healthcare technology APIs is designed to specifically address challenges faced by telehealth vendors and patients. Streamline your patient intake process with APIs for eligibility checking, claims submission and status, as well as responses and reporting.

APIs help vendors get to market faster and focus on rapid service expansion, with key solutions delivered in an easy-to-use, plug-and-play manner. Telehealth vendors need a streamlined intake process that helps them manage the large influx of patients with maximum efficiency.

Efficient

Our APIs translate standard ANSI X12 medical transactions to JSON so they are more accessible to developers, enabling efficient integration into users’ applications.

Extensive

We also provide extensive medical network API documentation through FAQs, getting started guides, JSON-to-EDI mappings and OpenAPI 3.0 annotated docs.

Supportive

Optum offers a comprehensive API bundle to help manage all aspects of telehealth operation. Providers should verify coverage of telehealth medical services before engaging.

Developer resources

Telehealth Medical Eligibility and Claims Management Bundle

API documentation

Included modules

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    Eligibility API

    The Eligibility API provides patient profile and benefits insights to help support accurate care delivery. Its primary function is to verify a patient’s insurance benefits status. This information helps ensure timely and accurate reimbursement.

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    Claims

    The Professional Claims API (837P) and the Institutional Claims API (837I) allow healthcare providers to submit claims for a service or encounter. 

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    Claims Status

    The Claims Status API (276/277) enables providers to check the status of previously submitted claims.

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    Claims Responses and Reports

    Our Claims Responses and Reports API connects directly to your mailbox where payers will send their responses and reports. Using our API, you can access these valuable payer files for claim status updates and remittance notifications. Many documents that payers send are unsolicited, so our API enables you to regularly check your mailbox for this critical information.

    Providers should verify insurance companies’ coverage of telehealth medical services before engaging in telehealth encounters and transactions.  

Our outcomes
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Automate benefit verifications and claim workflows

We provide innovative companies with the tools they need to navigate the complex ecosystem of member benefit and claim transactions.

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Simplify electronic claims and payment services

Our Provider Complete solution gives providers access to the largest financial and administrative network in the U.S. healthcare system.

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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.

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