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openapi: 3.2.0
info:
title: Medical Network Claim Status V2 Claim Status API
description: 276 Claim Status
version: V2
servers:
- url: https://sandbox-apigw.optum.com
description: Optum
tags:
- name: Claim Status API
description: Claim Status API
paths:
/claimstatus/v2/raw-x12/enhanced:
post:
tags:
- Claim Status API
summary: Check Claim Status x12
operationId: rawX12Enhanced
parameters:
- name: Authorization
in: header
description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
required: true
schema:
type: string
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/RawX12RequestExtension'
required: true
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/ExtendedClaimStatusResponse'
/medicalnetwork/claimstatus/v2/:
post:
tags:
- Claim Status API
summary: Check Claim Status
operationId: claimstatus
parameters:
- name: Authorization
in: header
description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
required: true
schema:
type: string
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/Request'
example:
controlNumber: '123456789'
tradingPartnerName: TestPayer
tradingPartnerServiceId: serviceId
providers:
- organizationName: TestProvider
firstName: John
lastName: Doe
npi: '1234567893'
spn: '123456'
tin: 0123456789
taxId: 0123456789
etin: ETIN12345
providerType: BillingProvider
subscriber:
memberId: '0000000000'
firstName: johnone
lastName: doeone
gender: M
dateOfBirth: '18800102'
groupNumber: '0000000000'
dependent:
firstName: janeone
lastName: doeone
gender: F
dateOfBirth: '18800101'
groupNumber: '0000000000'
encounter:
beginningDateOfService: '20100101'
endDateOfService: '20100102'
trackingNumber: ABCD
tradingPartnerClaimNumber: '1234567890'
locationIdentifier: LU12345
billingType: '111'
patientAccountNumber: PAT123456
pharmacyPrescriptionNumber: RX123456
clearingHouseClaimNumber: D9123456
submittedAmount: '100.00'
serviceLineInformation:
productOrServiceIDQualifier: AD
procedureCode: D0120
procedureModifiers: []
lineItemChargeAmount: '100.00'
revenueCode: '0123'
unitsOfServiceCount: '1'
lineItemControlNumber: FJ12345
serviceLineDate: '20100101'
serviceLineEndDate: '20100102'
required: true
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/Response'
/medicalnetwork/claimstatus/v2/healthcheck:
get:
tags:
- Claim Status API
summary: Health Check
operationId: healthCheck
parameters:
- name: Authorization
in: header
description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
required: true
schema:
type: string
responses:
'200':
description: OK
content:
application/vnd.changehealthcare.claimstatus-v2+json:
schema:
$ref: '#/components/schemas/HealthCheckResponse'
/medicalnetwork/claimstatus/v2/raw-x12:
post:
tags:
- Claim Status API
summary: Check Claim Status x12
operationId: rawX12
parameters:
- name: Authorization
in: header
description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
required: true
schema:
type: string
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/RawX12Request'
required: true
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/Response'
components:
schemas:
Extensions:
type: object
properties:
type:
type: string
description: 'NOTE: Allowed Values are: ''CLAIM_STATUS'' Request to include claim, check and cob extended claim status data in addition to the 277 response.'
enum:
- CLAIM_STATUS
required:
- type
Request:
type: object
properties:
controlNumber:
type: string
description: 'Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number'
example: '123456789'
maxLength: 9
minLength: 9
tradingPartnerName:
type: string
description: 'Loop: 2100A, Segment: NM1, Element: NM103, Notes: organizational name'
example: TestPayer
tradingPartnerServiceId:
type: string
description: 'Loop: 2100A Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI = Payer Identification'
example: serviceId
maxLength: 80
minLength: 2
providers:
type: array
description: 'Loop: 2100B, Loop: 2100C'
items:
$ref: '#/components/schemas/Provider'
maxItems: 2147483647
minItems: 1
subscriber:
$ref: '#/components/schemas/Subscriber'
description: 'Loop: 2000D'
dependent:
$ref: '#/components/schemas/Member'
description: 'Loop: 2000E'
encounter:
$ref: '#/components/schemas/Encounter'
description: 'Loop: 2200D or 2200E'
serviceLineInformation:
$ref: '#/components/schemas/ServiceLineInformation'
description: 'Loop: 2220D or 2220E'
required:
- controlNumber
- providers
- subscriber
ClaimStatus:
type: object
properties:
statusCategoryCode:
type: string
description: 'Segment: STC, Element: STC01-1, Notes: Status Category Code'
statusCategoryCodeValue:
type: string
description: 'Segment: STC, Element: STC01-1, Notes: Status Category Code value'
statusCode:
type: string
description: 'Segment: STC, Element: STC01-2, Notes: Status Code'
statusCodeValue:
type: string
description: 'Segment: STC, Element: STC01-2, Notes: Status Code value'
entityCode:
type: string
description: 'Segment: STC, Element: STC01-3, Notes: Entity Code'
entity:
type: string
description: 'Segment: STC, Element: STC01-3, Notes: Entity Code value'
effectiveDate:
type: string
description: 'Segment: STC, Element: STC02, Notes: Effective Date'
submittedAmount:
type: string
description: 'Segment: STC, Element: STC04, Notes: Total Claim Charge Amount'
amountPaid:
type: string
description: 'Segment: STC, Element: STC05, Notes: Claim Payment Amount'
paidDate:
type: string
description: 'Segment: STC, Element: STC06, Notes: Adjudication Finalized Date'
checkIssueDate:
type: string
description: 'Segment: STC, Element: STC08, Notes: Remittance Date'
checkNumber:
type: string
description: 'Segment: STC, Element: STC09, Notes: Remittance Trace Number'
secondaryStatusCategoryCode:
type: string
description: 'Segment: STC, Element: STC10-1, Notes: Status Category Code'
secondaryStatusCategoryCodeValue:
type: string
description: 'Segment: STC, Element: STC10-1, Notes: Status Category Code value'
secondaryStatusCode:
type: string
description: 'Segment: STC, Element: STC10-2, Notes: Status Code'
secondaryStatusCodeValue:
type: string
description: 'Segment: STC, Element: STC10-2, Notes: Status Code value'
secondaryEntityCode:
type: string
description: 'Segment: STC, Element: STC10-3, Notes: Entity Code'
secondaryEntity:
type: string
description: 'Segment: STC, Element: STC10-3, Notes: Entity Code value'
tertiaryStatusCategoryCode:
type: string
description: 'Segment: STC, Element: STC11-1, Notes: Status Category Code'
tertiaryStatusCategoryCodeValue:
type: string
description: 'Segment: STC, Element: STC11-1, Notes: Status Category Code value'
tertiaryStatusCode:
type: string
description: 'Segment: STC, Element: STC11-2, Notes: Status Code'
tertiaryStatusCodeValue:
type: string
description: 'Segment: STC, Element: STC11-2, Notes: Status Code value'
tertiaryEntityCode:
type: string
description: 'Segment: STC, Element: STC11-3, Notes: Entity Code'
tertiaryEntity:
type: string
description: 'Segment: STC, Element: STC11-3, Notes: Entity Code value'
trackingNumber:
type: string
description: 'Segment: TRN, Element: TRN02, Notes: Tracking Number'
claimServiceDate:
type: string
description: 'Segment: DTP, Element: DTP03, Notes: Claim Service Period'
tradingPartnerClaimNumber:
type: string
description: 'Segment: REF, Element: REF02, Notes: REF01 for this will be 1K'
patientAccountNumber:
type: string
description: 'Segment: REF, Element: REF02, Notes: REF01 for this will be EJ'
clearingHouseClaimNumber:
type: string
description: 'Segment: REF, Element: REF02, Notes: REF01 for this will be D9'
HealthCheckResponse:
type: object
properties:
status:
type: string
description: Health Status
example: UP
version:
type: string
description: API version
example: V2
ResponseExtensions:
type: object
properties:
statusCode:
type: string
description: 'NOTE: Allowed Values are: ''0'' Success, ''1'' Not Authorized, ''2'' Internal Error,''3'' Extension Not Applicable, ''4'' Extension Not Available At This time, ''5''Invalid Request Extension Type'
enum:
- '0'
- '1'
- '2'
- '3'
- '4'
- '5'
statusDescription:
type: string
extensions:
type: array
items:
$ref: '#/components/schemas/Extensions'
RequestExtensions:
type: object
properties:
extensions:
type: array
items:
$ref: '#/components/schemas/Extensions'
ContactInformation:
type: object
properties:
name:
type: string
description: 'Segment: PER, Element: PER02, Notes: Payer’s name.'
example: TEST PAYER DEPARTMENT
electronicDataInterChangeAccessNumber:
type: string
description: 'Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer''s electronic data interchange access number. PER03=PER05=PER07=ED'
example: '111111'
email:
type: string
description: 'Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer''s email. PER03=PER05=PER07=EM'
example: test@test.com
fax:
type: string
description: 'Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer''s facsimile number. PER03=PER05=PER07=FX'
example: 123-456-7890
phone:
type: string
description: 'Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer''s telephone number. PER03=PER05=PER07=TE'
example: 123-456-7890
phoneExtension:
type: string
description: 'Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer''s telephone extension. PER05=PER07=EX'
example: '0000'
TransactionIdentifier:
type: object
properties:
customerTransactionId:
type: string
description: The number assigned by the originator to identify the transaction within the originator's business application system
transactionId:
type: string
description: The number assigned by the originator to identify the transaction within the originator's business application system
ExtendedClaimStatusResponse:
type: object
properties:
x12:
type: string
extensions:
$ref: '#/components/schemas/ResponseExtensions'
Status:
type: object
properties:
statusCategoryCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC01-1, Notes: The health care claim status category code. Example: F3'
statusCategoryCodeValue:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC01-1, Notes: Value of the category code. F3 = Finalized/Revised - Adjudication information has been changed'
statusCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC01-2, Notes: Status code used to identify the status of an entire claim or a service line. Example: 3'
statusCodeValue:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC01-2, Notes: Status Code value. 3 = Claim has been adjudicated and is awaiting payment cycle.'
entityCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element STC01-3, Notes:Code for the entity. Example: 2P'
entity:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element STC01-3, Notes: Value of the entity code. Example: 2P=Public Health Service Facility'
secondaryStatusCategoryCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC10-1, Notes: The health care claim status category code. Example: F3'
secondaryStatusCategoryCodeValue:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC10-1, Notes: Value of the category code. F3 = Finalized/Revised - Adjudication information has been changed'
secondaryStatusCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC10-2, Notes: Status code used to identify the status of an entire claim or a service line. Example: 3'
secondaryStatusCodeValue:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC10-2, Notes: Status Code value. 3 = Claim has been adjudicated and is awaiting payment cycle.'
secondaryEntityCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element STC10-3, Notes:Code for the entity. Example: 2P'
secondaryEntity:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element STC10-3, Notes: Value of the entity code. Example: 2P=Public Health Service Facility'
tertiaryStatusCategoryCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC11-1, Notes: The health care claim status category code. Example: F3'
tertiaryStatusCategoryCodeValue:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC11-1, Notes: Value of the category code. F3 = Finalized/Revised - Adjudication information has been changed'
tertiaryStatusCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC11-2, Notes: Status code used to identify the status of an entire claim or a service line. Example: 3'
tertiaryStatusCodeValue:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC11-2, Notes: Status Code value. 3 = Claim has been adjudicated and is awaiting payment cycle.'
tertiaryEntityCode:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element STC11-3, Notes:Code for the entity. Example: 2P'
tertiaryEntity:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element STC11-3, Notes: Value of the entity code. Example: 2P=Public Health Service Facility'
effectiveDate:
type: string
description: 'Loop: 2220D and 2220E, Segment: STC, Element: STC02, Notes: Effective date of the status information. Date the service was placed in this status by the information source’s adjudication process. Date or Date range, format YYYYMMDD'
RawX12Request:
type: object
properties:
x12:
type: string
Response:
type: object
description: Response
properties:
controlNumber:
type: string
description: Provided by the submitter in the 270 Request. Transaction Set Control Number.
tradingPartnerServiceId:
type: string
description: ID used by Clearing House for the trading partner.
payer:
$ref: '#/components/schemas/Payer'
description: 'Loop: 2100A'
providers:
type: array
description: 'Loop: 2100B and 2100C'
items:
$ref: '#/components/schemas/Provider'
subscriber:
$ref: '#/components/schemas/Subscriber'
description: 'Loop: 2000D'
dependent:
$ref: '#/components/schemas/Member'
description: 'Loop: 2000E'
claims:
type: array
description: 'Loop: 2200D and 2200E'
items:
$ref: '#/components/schemas/Claim'
reassociationKey:
type: string
description: 'Segment: ISA, Element: ISA13, Notes: Interchange control number'
errorResponse:
$ref: '#/components/schemas/ErrorResponse'
status:
type: string
description: 'Loop: 2200D, Segment: STC, Element: STC01, Health care claim status, Used to convey status of the entire claim or specific service line.'
transactionSetAcknowledgement:
type: string
description: The 999 acknowledgment code
implementationTransactionSetSyntaxError:
type: string
description: The 999 syntax error code
x12:
type: string
description: Basic x12 edi response (for x12 endpoint)
meta:
$ref: '#/components/schemas/ResponseMeta'
description: Meta data about the request
ErrorDetail:
type: object
properties:
field:
type: string
description: Attribute that is bad
value:
type: string
description: Value of bad attribute
code:
type: string
description: 'Code for the error. Example: INVALID_VALUE'
description:
type: string
description: Description of the error code. Value provided in payer id should be a valid CHC assigned ERA payer ID
location:
type: string
description: 'Segment/location where the error occurred. If this is a network/system error, there is no location attribute. Example: $.payerBenefits[0].payer'
followupAction:
type: string
description: Any follow action required for the error. For AAA errors, this would be value for AAA04
Subscriber:
type: object
properties:
memberId:
type: string
description: 'Loop: 2100D, Segment: NM1, Element: NM109, Notes: The subscriber''s insurance member ID. Maps to subscriberId.'
example: '0000000000'
maxLength: 80
minLength: 2
firstName:
type: string
description: 'Loop: 2100D, Segment: NM1, Element: NM104, Notes: The subscriber''s first name as specified on their policy'
example: johnone
maxLength: 35
minLength: 1
lastName:
type: string
description: 'Loop: 2100D, Segment: NM1, Element: NM103, Notes: The subscriber''s last name as specified on their policy.'
example: doeone
maxLength: 60
minLength: 1
gender:
type: string
description: 'Loop: 2000D, 2000E, Segment: DMG, Element: DMG03, Notes: The subscriber''s gender as specified on their policy.'
enum:
- M
- F
- U
example: M
pattern: F|M|U
dateOfBirth:
type: string
description: 'Loop: 2000D, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the subscriber. Maps to BirthDate'
example: '18800102'
groupNumber:
type: string
description: 'Loop: 2200D, Segment: REF, Element: REF01, Notes: The group number associated with the subscriber.'
example: '0000000000'
maxLength: 50
minLength: 1
required:
- firstName
- lastName
- memberId
Provider:
type: object
properties:
organizationName:
type: string
description: 'Segment: NM1, Element: NM103, Notes: Provider’s organization name. Can use organization or last name.'
example: TestProvider
maxLength: 60
minLength: 1
firstName:
type: string
description: 'Segment: NM1, Element: NM104, Notes: Maps to providerName'
maxLength: 35
minLength: 1
example: John
lastName:
type: string
description: 'Segment: NM1, Element: NM103, Notes: Provider last name. Can use organization or last name.'
maxLength: 60
minLength: 1
example: Doe
npi:
type: string
description: 'Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: National Provider Identification. Maps to provider NPI. NM108=XX'
maxLength: 80
minLength: 2
example: '1234567893'
spn:
type: string
description: 'Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: Service Provider Number. Maps to provider SPN. NM108=SV'
maxLength: 80
minLength: 2
example: '123456'
tin:
type: string
description: 'Loop: 2100B, 2100C, Segment: NM1, Element: NM109, Notes: Taxpayer’s Identification Number. Maps to provider TIN. NM108=FI'
maxLength: 80
minLength: 2
example: 0123456789
taxId:
type: string
description: 'Loop: 2100B, Segment: NM1, Element: NM109, Notes: Taxpayer’s Identification Number used when ProviderType = BillingProvider'
example: 0123456789
maxLength: 80
minLength: 2
etin:
type: string
description: 'Loop: 2100B, Segment: NM1, Element: NM109, Notes: Electronic transmitter identification Number (ETIN) used when ProviderType = BillingProvider'
maxLength: 80
minLength: 2
example: ETIN12345
providerType:
type: string
description: 'Segment: NM1, Notes: Code for entity (Billing or Service) Billing Provider: Loop 2100B, NM101=41 (required), Service Provider: Loop 2100C, NM101=1P if not present it is added and assigned tin = BillingProvider taxId'
enum:
- BillingProvider
- ServiceProvider
example: BillingProvider
pattern: BillingProvider|ServiceProvider
required:
- providerType
Payer:
type: object
description: Payer
properties:
organizationName:
type: string
description: 'Segment: NM1, Element: NM103, Notes: Payers’s organization name.'
example: TestPayer
payerIdentification:
type: string
description: 'Segment: NM1, Element: NM109, Notes: Payers’s identification number established through trading partner agreement. NM108=PI'
example: '12345'
centersForMedicareAndMedicaidServicePlanId:
type: string
description: 'Segment: NM1, Element: NM109, Notes: Use when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). NM108=XV'
example: '12345'
contactInformation:
$ref: '#/components/schemas/ContactInformation'
description: 'Segment: PER'
Encounter:
type: object
properties:
beginningDateOfService:
type: string
description: 'Loop: 2200D or 2200E, Segment: DTP, Element: DTP03, Notes: Date Time Period - Start Date'
example: '20100101'
endDateOfService:
type: string
description: 'Loop: 2200D or 2200E, Segment: DTP, Element: DTP03, Notes: Date Time Period - End Date'
example: '20100102'
trackingNumber:
type: string
description: 'Loop: 2200D or 2200E, Segment: TRN, Element: TRN02, Notes: This is the claim status tracking number assigned to the status query for the claim.'
example: ABCD
maxLength: 50
minLength: 1
tradingPartnerClaimNumber:
type: string
description: 'Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: This is the payer assigned claim number. descriptions goes in REF02 where REF01=1K'
maxLength: 50
minLength: 1
example: '1234567890'
locationIdentifier:
type: string
description: 'Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Required if application or location system identifier is known. descriptions goes in REF02 where REF01=LU'
maxLength: 50
minLength: 1
example: LU12345
billingType:
type: string
description: 'Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Billing type reference ID. Example: billing type for inpatient services is 111. descriptions goes in REF02 where REF01=BLT'
maxLength: 50
minLength: 1
example: '111'
patientAccountNumber:
type: string
description: 'Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Patient account number provided by service provider. description goes in REF02 where REF01=EJ'
maxLength: 50
minLength: 1
example: PAT123456
pharmacyPrescriptionNumber:
type: string
description: 'Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Patient pharmacy prescription number. description goes in REF02 where REF01=XZ'
maxLength: 50
minLength: 1
example: RX123456
clearingHouseClaimNumber:
type: string
description: 'Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Claim number provided by clearing house. description goes in REF02 where REF01=D9'
maxLength: 50
minLength: 1
example: D9123456
submittedAmount:
type: string
description: 'Loop: 2200D or 2200E, Segment: AMT, Element: AMT02, Notes: Submitted total charges. description goes in AMT02 where AMT01=T3'
maxLength: 18
minLength: 1
example: '100.00'
ServiceDetail:
type: object
properties:
service:
$ref: '#/components/schemas/Service'
description: 'Loop: 2220D, 2220E, Segment: SVC, Notes: Service Line Information'
status:
type: array
description: 'Loop: 2220D, 2220E, Segment: STC, Notes: Service Line Status Information'
items:
$ref: '#/components/schemas/Status'
RawX12RequestExtension:
type: object
properties:
x12:
type: string
extensions:
$ref: '#/components/schemas/RequestExtensions'
ErrorResponse:
type: object
properties:
code:
type: string
description: Code for the error.
example: INVALIDMISSINGINPUTDATA
description:
type: string
description: Description of the error code. Value provided in payer id should be a valid CHC assigned ERA payer Id.
transactionIdentifier:
$ref: '#/components/schemas/TransactionIdentifier'
errors:
type: array
items:
$ref: '#/components/schemas/ErrorDetail'
ResponseMeta:
type: object
properties:
submitterId:
type: string
description: submitterId assigned to this request
senderId:
type: string
description: senderId assigned to this request
billerId:
type: string
description: billerId assigned to this request
traceId:
type: string
description: Unique Id assigned to each request by Optum
applicationMode:
type: string
description: Used by Optum to identify where this request can be found for support
Claim:
type: object
properties:
claimStatus:
$ref: '#/components/schemas/ClaimStatus'
description: 'Loop: 2200D, 2200E'
serviceDetails:
type: array
description: 'Loop: 2220D, 2220E'
items:
$ref: '#/components/schemas/ServiceDetail'
Member:
type: object
properties:
firstName:
type: string
description: 'Loop: 2100E, Segment: NM1, Element: NM104, Notes: The dependent''s first name as specified on their policy.'
example: janeone
maxLength: 35
minLength: 1
lastName:
type: string
description: 'Loop: 2100E, Segment: NM1, Element: NM103, Notes: The dependent''s last name as specified on their policy.'
example: doeone
maxLength: 60
minLength: 1
gender:
type: string
description: 'Loop: 2000E, Segment: DMG, Element: DMG03, Notes: dependent''s gender as specified on their policy.'
enum:
- M
- F
- U
example: F
pattern: F|M|U
dateOfBirth:
type: string
description: 'Loop: 2000E, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the dependent.'
example: '18800101'
groupNumber:
type: string
description: 'Loop: 2200E, Segment: REF, Element: REF02 when REF01=6P, Notes: The group number associated with the subscriber and dependent. Maps to dependent groupNumber.'
example: '0000000000'
maxLength: 50
minLength: 1
required:
- firstName
- lastName
ServiceLineInformation:
type: object
properties:
productOrServiceIDQualifier:
type: string
description: 'Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-1, Notes: Allowed Values are ''AD'' American Dental Association Codes, ''ER'' Jurisdiction Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, ''HP'' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, ''IV'' Home Infusion EDI Coalition (HIEC) Product/Service Code, ''N4'' National Drug Code in 5-4-2 Format, ''NU'' National Uniform Billing Committee (NUBC) UB92 Codes, ''WK'' Advanced Billing Concepts (ABC) Codes'
enum:
- AD
- ER
- HC
- HP
- IV
- N4
- NU
- WK
procedureCode:
type: string
description: 'Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-2, Notes: Procedure Code maps to Product/Serv
# --- truncated at 32 KB (35 KB total) ---
# Full source: https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-claim-status-api-api-openapi.yml