Optum

Optum CMS HCC APIs API

The CMS HCC APIs API from Optum — 3 operation(s) for cms hcc apis.

GitHub OpenAPI

Operations 3

GET /api/cms/common/hcc/{hccType}/{hccCode}/diagnosis-codes Fetches diagnosis codes on selected hcc type and hcc code #
GET /api/cms/common/hcc/{hccType}/codes Fetches hcc type specific codes #
GET /api/cms/common/hcc/{codetype}/{code}/code Fetches hcc codes for the given diagnosis code #

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-cms-hcc-apis-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-cms-hcc-apis-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Optum CMS HCC APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged CMS HCC APIs across 2 of this provider''s published API definitions: optum-cms-common-facility-openapi.yml, optum-cms-common-physician-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: /v1/cmscommonms
tags:
- name: CMS HCC APIs
paths:
  /api/cms/common/hcc/{hccType}/{hccCode}/diagnosis-codes:
    get:
      tags:
      - CMS HCC APIs
      summary: Fetches diagnosis codes on selected hcc type and hcc code
      operationId: getDiagnosisCodes
      parameters:
      - name: hccType
        in: path
        required: true
        schema:
          type: string
          enum:
          - CMS_HCC
          - CMS_HCC_ESRD
          - RX_HCC_V04
          - HHS_HCC
      - name: hccCode
        in: path
        description: HCC Types
        required: true
        schema:
          type: string
        example: HCC1
      - name: sort
        in: query
        description: Any of these (diagnosisCode,-diagnosisCode) are allowed values, default is diagnosisCode
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - diagnosisCode
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: filter
        in: query
        required: false
        schema:
          type: string
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: 'Fetches diagnosis codes for the given hcc code '
          content:
            application/json:
              example:
              - diagnosisCode: B20
                diagnosisCodeDesc: Human immunodeficiency virus [HIV] disease
              - diagnosisCode: B97.35
                diagnosisCodeDesc: Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere
              - diagnosisCode: Z21
                diagnosisCodeDesc: Asymptomatic human immunodeficiency virus [HIV] infection status
        '400':
          description: Bad Request - some parameters were invalid
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                error:
                - sort parameter value should be from list of [diagnosisCode]
                warning: null
                info: null
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/common/hcc/{hccType}/{hccCode}/hcc-diagnosis-
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/common/hcc/{hccType}/codes:
    get:
      tags:
      - CMS HCC APIs
      summary: 'Fetches hcc type specific codes '
      operationId: getHCCCodes
      parameters:
      - name: hccType
        in: path
        description: Fetches HCC codes on selected hcc type
        required: true
        schema:
          type: string
          enum:
          - CMS_HCC
          - CMS_HCC_ESRD
          - RX_HCC_V04
          - HHS_HCC
      - name: sort
        in: query
        description: Any of these (hccCode,-hccCode) are allowed values, default is hccCode
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - hccCode
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetches hcc codes from the selected hcc type
          content:
            application/json:
              example: "[{\n      \"hccCode\": \"HCC1\",\n        \"hccCodeDesc\": \"HIV/AIDS\"\n      },\n      {\n        \"hccCode\": \"HCC2\",\n        \"hccCodeDesc\": \"Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock\"\n      },\n      {\n        \"hccCode\": \"HCC6\",\n        \"hccCodeDesc\": \"Opportunistic Infections\"\n      },]\n"
        '400':
          description: 'Bad Request: Some parameters were invalid'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                error:
                - sort parameter value should be from list of [hccCode]
                warning: null
                info: null
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-08-04T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/common/hcc/{hccType}/cod
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/common/hcc/{codetype}/{code}/code:
    get:
      tags:
      - CMS HCC APIs
      summary: Fetches hcc codes for the given diagnosis code
      operationId: getHCCDiagnosisCodes
      parameters:
      - name: codetype
        in: path
        required: true
        schema:
          type: string
          enum:
          - i10_cm
          - i9v1
      - name: code
        in: path
        required: true
        schema:
          type: string
        example: B20
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetches hcc codes for the given diagnosis code
          content:
            application/json:
              example:
                cmsHCC:
                - hccCode: HCC1
                  hccCodeDesc: HIV/AIDS
                cmsHCCESRD:
                - hccCode: HCC1
                  hccCodeDesc: HIV/AIDS
                rxHCC:
                - hccCode: RXHCC1
                  hccCodeDesc: HIV/AIDS
                hhsHCC:
                - hccCode: HCC1
                  hccCodeDesc: HIV/AIDS
        '400':
          description: 'Bad Request: Some parameters were invalid'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                error:
                - The code provided '992133' in this web service request is not a valid 'I10_CM' code.
                warning: null
                info: null
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/common/hcc/I10_CM/{code}/codes
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
components:
  schemas:
    Notification:
      type: object
      properties:
        error:
          type: array
          items:
            type: string
        warning:
          type: array
          items:
            type: string
        info:
          type: array
          items:
            type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-refined-from:
- optum-cms-common-facility-openapi.yml
- optum-cms-common-physician-openapi.yml
x-readme:
  explorer-enabled: true
  proxy-enabled: true