Optum

Optum Compliance APIs API

The Compliance APIs API from Optum — 5 operation(s) for compliance apis.

GitHub OpenAPI

Operations 5

POST /api/optum/common/physician/compliance/abn-form #
GET /api/optum/common/{contractor}/medicare-contractors Fetches medicare contractors list for a given contractor Type. #
GET /api/optum/common/source-rationale Get Source Rationale #
GET /api/optum/common/get-policy-url/{contractror-id}/{policy-id} Get Policy URL #
GET /api/optum/common/compliance/place-of-service-codes #

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-compliance-apis-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-compliance-apis-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Optum Compliance APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged Compliance APIs across 2 of this provider''s published API definitions: optum-optum-common-facility-openapi.yml, optum-optum-common-physician-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: /v1/optumcommonms
tags:
- name: Compliance APIs
paths:
  /api/optum/common/physician/compliance/abn-form:
    post:
      tags:
      - Compliance APIs
      operationId: getABNForm
      parameters:
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ABNForm'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: string
                format: byte
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /api/optum/common/{contractor}/medicare-contractors:
    get:
      tags:
      - Compliance APIs
      summary: Fetches medicare contractors list for a given contractor Type.
      operationId: fetchMedicareContractors
      parameters:
      - name: sort
        in: query
        description: Any of these values (id, name) are allowed.The default is id
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - id
      - name: contractor
        in: path
        required: true
        schema:
          type: string
          enum:
          - physician
          - facility
      - 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: OK
          content:
            '*/*':
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/ContractorValue'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /api/optum/common/source-rationale:
    get:
      tags:
      - Compliance APIs
      summary: Get Source Rationale
      operationId: getSourceRationale
      parameters:
      - name: ddrId
        in: query
        required: false
        schema:
          type: string
      - name: mnemonic
        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: OK
          content:
            '*/*':
              schema:
                $ref: '#/components/schemas/PhysicianClaimSourceRationale'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /api/optum/common/get-policy-url/{contractror-id}/{policy-id}:
    get:
      tags:
      - Compliance APIs
      summary: Get Policy URL
      operationId: getPolicyURL
      parameters:
      - name: contractror-id
        in: path
        required: true
        schema:
          type: string
      - name: policy-id
        in: path
        required: true
        schema:
          type: string
      - name: from-date
        in: query
        required: true
        schema:
          type: string
      - name: to-date
        in: query
        required: true
        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: OK
          content:
            '*/*':
              schema:
                type: string
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /api/optum/common/compliance/place-of-service-codes:
    get:
      tags:
      - Compliance APIs
      operationId: getPlaceOfServiceCodes
      parameters:
      - 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: OK
          content:
            '*/*':
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/PlaceOfServiceValue'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
components:
  schemas:
    PhysicianClaimSourceRationale:
      type: object
      properties:
        ddrId:
          type: string
        mnemonic:
          type: string
        editMessage:
          type: string
        source:
          type: string
        editType:
          type: string
        sourceInfo:
          type: string
        sourceUrl:
          type: string
        description:
          type: string
    ContractorValue:
      type: object
      properties:
        contractorNumber:
          type: string
        contractorName:
          type: string
    PlaceOfServiceValue:
      type: object
      properties:
        code:
          type: string
        description:
          type: string
    ABNItemService:
      type: object
      properties:
        codeItemService:
          type: string
        estimatedCost:
          type: string
        patientAction:
          type: string
        medicareNoPayReason:
          type: string
        spanishMedicareReason:
          type: string
    ABNForm:
      type: object
      properties:
        notifierName:
          type: string
        notifierAddress:
          type: string
        notifierPhone:
          type: string
        patientName:
          type: string
        patientIdentifier:
          type: string
        itemServices:
          type: array
          items:
            $ref: '#/components/schemas/ABNItemService'
        additionalInfo:
          type: string
        isEnglishPDF:
          type: boolean
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-refined-from:
- optum-optum-common-facility-openapi.yml
- optum-optum-common-physician-openapi.yml
x-readme:
  explorer-enabled: true
  proxy-enabled: true