Optum

Optum Eligibility Requests API

Submit new real-time eligibility transactions. These endpoints accept either a normalized JSON request or a JSON request body with `x12` set to the X12 270 payload, and return a normalized JSON eligibility response. When a customer is enrolled in integrated Coverage Discovery, these operations may also return related discovery task links in the response headers.

GitHub OpenAPI
Business capability
Eligibility & Benefits Verification BC-2800.30

Operations 2

POST /rcm/eligibility/v1 Submit a new eligibility request #
POST /rcm/eligibility/v1/real-time/x12 Submit a new X12 270 eligibility request #

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-requests-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-eligibility-requests-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Enhanced Eligibility Eligibility Requests API
  description: Enhanced Eligibility provides real-time eligibility verification for medical benefit inquiries and optional Coverage Discovery workflows when additional coverage needs to be researched asynchronously.
  version: v0.2.0
servers:
- url: https://sandbox-apigw.optum.com
  description: Sandbox server (uses test data)
- url: https://apigw.optum.com
  description: Production server (uses live data)
tags:


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