Optum

Optum Claim Pre Check API

The ClaimPreCheck API from Optum — 1 operation(s) for claimprecheck.

Documentation GitHub OpenAPI

Business capability

Claim Production & Submission BC-2870.30

Operations 1

POST /pre-service/v1/claim/precheck Call claimPreCheck query #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Claim Pre Check API
  description: Claim Pre Check  API
  version: 1.0.0
servers:
- url: https://sandbox-apigw.optum.com/oihub
tags:
- name: ClaimPreCheck
paths:
  /pre-service/v1/claim/precheck:
    description: '> **Note:**

      > **For Claims Pre-check**

      >

      > **Supported Payer ID’s for UnitedHealthcare:**

      >87726  03432   96385 95467 86050 86047 95378 06111 00773 36273 37602 39026 41161 41194 52461 65088 74227 76342 76343 78857 81400 88337  94265  95958  USN01  25463  UHNDC

      '
    post:
      summary: Call claimPreCheck query
      operationId: claimPreCheck
      tags:
      - ClaimPreCheck
      security:
      - oAuth:
        - read_healthcheck
      parameters:
      - name: providerTaxId
        in: header
        description: Provider Tax ID
        required: true
        schema:
          example: '4466554400'
          type: string
      - name: x-optum-consumer-correlation-id
        in: header
        description: Unique UUID to track the transaction
        required: false
        schema:
          example: x-optum-consumer-correlation-id
          type: string
      - name: environment
        in: header
        description: Environment
        required: false
        schema:
          example: sandbox
          type: string
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ClaimPreCheckRequest'
          application/graphql:
            schema:
              type: object
              properties:
                query:
                  type: string
                  example: 'query claimPreCheck($input: ClaimInput!) { claimPreCheck(input: $input) { transactionId x12ResponseData responseType x12Response277CA message statusCode } }

                    '
                variables:
                  type: object
                  properties:
                    input:
                      type: object
                      example:
                        x12RequestData: ISA*00*...
                        payerId: P123
      responses:
        '200':
          description: Successful response
          content:
            application/json:
              example:
                data:
                  claimPreCheck:
                    transactionId: '12345'
                    x12ResponseData: ISA*00*...
                    responseType: Success
                    x12Response277CA: 277CA*00*...
                    message: Claim Pre-Check Successful
                    statusCode: '200'
              schema:
                type: object
                properties:
                  data:
                    description: Claim Pre-Check Response data
                    $ref: '#/components/schemas/ClaimPreCheckResponseWrapper'
        '400':
          description: Bad Request
          content:
            application/json:
              example:
                errors:
                - message: 'Validation error (FieldUndefined@[claimPreCheck/x12ResponseDate]) : Field ''x12ResponseDate'' in type ''ClaimPreCheckResponse'' is undefined'
                  locations:
                  - column: 92
                    line: 1
                  extensions:
                    classification: ValidationError
        '401':
          description: UnAuthorized
          content:
            application/json:
              example:
                message: UnAuthorized
                statusCode: 401
        '500':
          description: Internal Server Error
          content:
            application/json:
              example:
                message: Internal server error
                statusCode: 500
components:
  schemas:
    Variables:
      type: object
      properties:
        input:
          description: Input data for the Claims Pre-Check operation
          $ref: '#/components/schemas/Input'
    ClaimPreCheckResponse:
      type: object
      properties:
        transactionId:
          description: Transaction ID
          example: '12345'
          type: string
        x12ResponseData:
          description: X12 Response Data
          example: ISA*00*...
          type: string
        responseType:
          description: Response Type
          example: Success
          type: string
        x12Response277CA:
          description: X12 Response 277CA
          example: 277CA*00*...
          type: string
        message:
          description: Response Message
          example: Claim Pre-Check Successful
          type: string
        statusCode:
          description: Status Code
          example: '200'
          type: string
      description: Response model for Claim Pre-Check operations
    ClaimPreCheckResponseWrapper:
      type: object
      properties:
        claimPreCheck:
          description: Claim Pre-Check Response data
          $ref: '#/components/schemas/ClaimPreCheckResponse'
      description: Wrapper for Claim Pre-Check Response
    Input:
      type: object
      properties:
        x12RequestData:
          description: 837X12 request data for Institutional/Professional claims
          example: ISA*00*...
          type: string
        payerId:
          description: Payer ID
          example: '123456789'
          type: string
      required:
      - payerId
      - x12RequestData
    ClaimPreCheckRequest:
      type: object
      properties:
        query:
          description: GraphQL query for the Claims Pre-Check operation
          example: 'query claimPreCheck($input: ClaimInput!) { claimPreCheck(input: $input) { transactionId x12ResponseData responseType x12Response277CA message statusCode } }

            '
          type: string
        variables:
          description: Variables for the Claims Pre-Check operation
          $ref: '#/components/schemas/Variables'
  securitySchemes:
    oAuth:
      type: oauth2
      description: This API uses OAuth 2 with the client_credentials grant flow.
      flows:
        clientCredentials:
          tokenUrl: /apip/auth/v2/token
          scopes:
            read_txn: read transactions
            create_txn: submit a new transaction request
            read_coveragediscovery: read coverage discovery tasks
            create_coveragediscovery: submit a new coverage discovery task
            read_healthcheck: check the status of the system
x-readme:
  explorer-enabled: true
  proxy-enabled: true