Optum

Optum Claim Status API

The Claim Status API from Optum — 1 operation(s) for claim status.

GitHub OpenAPI
Business capability
Claim Production & Submission BC-2870.30

Operations 1

POST /oihub/dental/claim/inquiry/v1 Claim Status #

Documentation

📖
APIReference
https://developer.optum.com/eligibilityandclaims/reference/api-overview
📖
GettingStarted
https://developer.optum.com/eligibilityandclaims/docs/get-started-with-optum-api
📖
Authentication
https://developer.optum.com/eligibilityandclaims/docs/optum-security-and-authorization
📖
APIReference
https://developer.optum.com/optumreal-dental/reference/overview-real-dental
📖
GettingStarted
https://developer.optum.com/optumreal-dental/reference/get-started
📖
APIReference
https://developer.optum.com/pharmacysolutions/reference
📖
APIReference
https://developer.optum.com/paymentandreimbursement/reference
📖
APIReference
https://developer.optum.com/platformandinteroperability/reference
📖
APIReference
https://developer.optum.com/analyticsandinsights/reference
📖
APIReference
https://developer.optum.com/apitools/reference/security-and-authorization-v2-overview
📖
Documentation
https://developer.optum.com/apitools/docs/getting-started

Specifications

⚙
OpenAPI
https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-claim-status-api-openapi.yml

Other Resources

🔗
ChangeLog
https://developer.optum.com/eligibilityandclaims/docs/eligibility-release-notes

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OpenAPI Specification

optum-claim-status-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Real Dental Claim Status API
  version: 1.0.0
  description: OpenAPI specification for the Real Dental Claim Status GraphQL API.
servers:
- url: https://sandbox-apigw.optum.com
security:
- bearerAuth: []
tags:
- name: Claim Status
paths:
  /oihub/dental/claim/inquiry/v1:
    post:
      tags:
      - Claim Status
      summary: Claim Status
      description: Search claim status information and retrieve 277CA acknowledgements.
      operationId: claimStatus
      security:
      - bearerAuth: []
      parameters:
      - name: providerTaxId
        in: header
        required: true
        description: Provider Tax ID
        schema:
          type: string
          example: '123456789'
      - name: x-optum-consumer-correlation-id
        in: header
        required: false
        description: Unique UUID used to track the transaction.
        schema:
          type: string
          example: 4d4a8964-e5fa-42dc-a37d-12345789
      - name: environment
        in: header
        required: false
        description: Environment identifier.
        schema:
          type: string
          example: sandbox
      - name: nextPageToken
        in: header
        required: false
        description: Paging identifier to access the next set of records, when applicable.
        schema:
          type: string
          example: eyJwYWdlIjoyfQ==
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/GraphQLClaimStatusRequest'
            examples:
              SearchClaim:
                summary: Search Claim Status
                value:
                  operationName: SearchClaim
                  query: 'query SearchClaim($searchClaimInput: SearchClaimInput!) { searchClaim(searchClaimInput: $searchClaimInput) { claims { claimNumber claimStatus } pagination { hasMoreRecords nextPageToken } } }'
                  variables:
                    searchClaimInput:
                      payerId: '87726'
                      claimNumber: AAAAAAAAAAA1
                      billingProviderTin: 0123456789
                      submitterId: SUBMITTER001
                      memberId: '0000000000'
                      memberFirstName: johnone
                      memberLastName: doeone
                      memberDateOfBirth: '18800102'
                      serviceStartDate: '20100101'
                      serviceEndDate: '20100102'
              Search277CA:
                summary: Search 277CA
                value:
                  operationName: Search277CA
                  query: 'query Search277CA($search277CAInput: Search277CAInput!) { search277CA(search277CAInput: $search277CAInput) { responseType x12ResponseData statuscode message } }'
                  variables:
                    search277CAInput:
                      transactionId: '123456789'
                      payerId: '87726'
      responses:
        '200':
          description: Successful operation
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/GraphQLClaimStatusResponse'
              examples:
                SearchClaimResponse:
                  summary: Search Claim Response
                  value:
                    data:
                      searchClaim:
                        claims:
                        - claimNumber: AAAAAAAAAAA1
                          claimStatus: PROCESSED
                        pagination:
                          hasMoreRecords: true
                          nextPageToken: eyJwYWdlIjoyfQ==
                Search277CAResponse:
                  summary: Search277CA Response
                  value:
                    data:
                      search277CA:
                        responseType: ACK
                        x12ResponseData: ISA*00*          *00*          *ZZ*ABCDEFGHIJKLMNO...
                        statuscode: '200'
                        message: Transaction processed successfully
        '400':
          description: Bad request
        '401':
          description: Unauthorized
        '500':
          description: Internal server error
components:
  schemas:
    GraphQLClaimStatusRequest:
      type: object
      required:
      - query
      - variables
      properties:
        operationName:
          type: string
          description: GraphQL operation name.
        query:
          type: string
          description: GraphQL query.
        variables:
          type: object
          description: GraphQL variables.
          properties:
            searchClaimInput:
              $ref: '#/components/schemas/SearchClaimInput'
            search277CAInput:
              $ref: '#/components/schemas/Search277CAInput'
          additionalProperties: false
      additionalProperties: false
    GraphQLClaimStatusResponse:
      type: object
      properties:
        data:
          type: object
          properties:
            searchClaim:
              type: object
              properties:
                claims:
                  type: array
                  items:
                    type: object
                pagination:
                  type: object
                  properties:
                    hasMoreRecords:
                      type: boolean
                    nextPageToken:
                      type: string
            search277CA:
              type: object
              properties:
                responseType:
                  type: string
                x12ResponseData:
                  type: string
                statuscode:
                  type: string
                message:
                  type: string
        errors:
          type: array
          items:
            type: object
      additionalProperties: true
    Search277CAInput:
      type: object
      required:
      - transactionId
      - payerId
      additionalProperties: false
      properties:
        transactionId:
          type: string
          example: '123456789'
        payerId:
          type: string
          example: '87726'
    SearchClaimInput:
      type: object
      required:
      - payerId
      additionalProperties: false
      properties:
        payerId:
          type: string
          example: '87726'
        claimNumber:
          type: string
          example: AAAAAAAAAAA1
        billingProviderTin:
          type: string
          example: 0123456789
        submitterId:
          type: string
          example: SUBMITTER001
        memberId:
          type: string
          example: '0000000000'
        memberFirstName:
          type: string
          example: johnone
        memberLastName:
          type: string
          example: doeone
        memberDateOfBirth:
          type: string
          example: '18800102'
        serviceStartDate:
          type: string
          example: '20100101'
        serviceEndDate:
          type: string
          example: '20100102'
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
      description: Enter the bearer token.
x-readme:
  explorer-enabled: true
  proxy-enabled: true