Optum

Optum Eligibility API

Medical Eligibility

GitHub OpenAPI
Business capability
Eligibility & Benefits Verification BC-2800.30

Operations 4

POST /medicalnetwork/eligibility/v3/ Check Eligibility #
POST /medicalnetwork/eligibility/v3/raw-x12 Check Eligibility x12 #
POST /eligibility/v1/pre-service/member Call checkEligibility query #
POST /oihub/dental/eligibility/preservice/v1 Pre-Care Eligibility Check #

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-eligibility-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-eligibility-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Optum Eligibility API
  version: '1.0'
  description: 'Operations tagged Eligibility across 3 of this provider''s published API definitions: optum-medical-network-eligibility-v3-openapi.yml, optum-optum-real-pre-service-eligibility-api-openapi.yml, optum-real-dental-pre-care-eligibility-api-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: https://sandbox-apigw.optum.com
  description: ''
- url: https://sandbox-apigw.optum.com/oihub
tags:


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# Full source: https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-eligibility-api-openapi.yml