Optum

Optum Facility Compliance APIs API

The Facility Compliance APIs API from Optum — 12 operation(s) for facility compliance apis.

GitHub OpenAPI
Business capability
Claim Production & Submission BC-2870.30

Operations 12

PUT /app/optum/facility/claim/update Update the claim #
PUT /app/optum/facility/claim/update-claim-line Update the claim line #
PUT /app/optum/facility/claim/update-claim-diagnosis Update the claim diagnosis #
POST /app/optum/facility/claim/submit/{compliance-type}/{scenario-number} Submit claim #
POST /app/optum/facility/claim/reset Reset claim #
POST /app/optum/facility/claim/create Inserts a new claim #
POST /app/optum/facility/claim/create-claim-line Inserts a new claim line #
POST /app/optum/facility/claim/create-claim-diagnosis Inserts a new claim diagnosis #
GET /app/optum/facility/claim/details/{compliance-type}/{scenario-number} Get claim #
GET /app/optum/facility/claim/abn/{scenario-number} Get applicable codes for ABN #
DELETE /app/optum/facility/claim/delete/claim-line-edits Delete claim line edits #
DELETE /app/optum/facility/claim/delete-claim-line/{claim-line-id} Delete the claim line #

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-facility-compliance-apis-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-facility-compliance-apis-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Optum Facility Compliance APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged Facility 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: Facility Compliance APIs
paths:
  /app/optum/facility/claim/update:
    put:
      tags:
      - Facility Compliance APIs
      summary: Update the claim
      operationId: updateClaim
      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/FacilityClaimUpdate'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: string
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/update-claim-line:
    put:
      tags:
      - Facility Compliance APIs
      summary: Update the claim line
      operationId: updateClaimLine
      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/FacilityClaimUpdate'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: string
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/update-claim-diagnosis:
    put:
      tags:
      - Facility Compliance APIs
      summary: Update the claim diagnosis
      operationId: updateClaimDiagnosis
      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/FacilityClaimUpdate'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: string
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/submit/{compliance-type}/{scenario-number}:
    post:
      tags:
      - Facility Compliance APIs
      summary: Submit claim
      operationId: submitClaim
      parameters:
      - name: compliance-type
        in: path
        required: true
        schema:
          type: integer
          format: int32
      - name: scenario-number
        in: path
        required: true
        schema:
          type: integer
          format: int32
      - name: moduleId
        in: query
        required: true
        schema:
          type: string
          enum:
          - '106'
          - '105'
      - 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/FacilityClaimResponse'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/reset:
    post:
      tags:
      - Facility Compliance APIs
      summary: Reset claim
      operationId: resetClaim
      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/FacilityClaim'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: integer
                format: int64
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/create:
    post:
      tags:
      - Facility Compliance APIs
      summary: Inserts a new claim
      operationId: createClaim
      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/FacilityClaim'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: integer
                format: int64
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/create-claim-line:
    post:
      tags:
      - Facility Compliance APIs
      summary: Inserts a new claim line
      operationId: createClaimLine
      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/FacilityClaimLine'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: integer
                format: int64
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/create-claim-diagnosis:
    post:
      tags:
      - Facility Compliance APIs
      summary: Inserts a new claim diagnosis
      operationId: createClaimDiagnosis
      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/FacilityClaimDiag'
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: string
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/details/{compliance-type}/{scenario-number}:
    get:
      tags:
      - Facility Compliance APIs
      summary: Get claim
      operationId: getClaim
      parameters:
      - name: compliance-type
        in: path
        required: true
        schema:
          type: integer
          format: int32
      - name: scenario-number
        in: path
        required: true
        schema:
          type: integer
          format: int32
      - name: moduleId
        in: query
        required: true
        schema:
          type: string
          enum:
          - '106'
          - '105'
      - 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/FacilityClaim'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/abn/{scenario-number}:
    get:
      tags:
      - Facility Compliance APIs
      summary: Get applicable codes for ABN
      operationId: getAbnCodes
      parameters:
      - name: scenario-number
        in: path
        required: true
        schema:
          type: integer
          format: int32
      - 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/Code'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/delete/claim-line-edits:
    delete:
      tags:
      - Facility Compliance APIs
      summary: Delete claim line edits
      operationId: deleteClaimLineEdits
      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:
              type: array
              items:
                type: integer
                format: int32
        required: true
      responses:
        '200':
          description: OK
          content:
            '*/*':
              schema:
                type: string
      security:
      - bearerAuth: []
    servers:
    - url: /v1/optumcommonms
  /app/optum/facility/claim/delete-claim-line/{claim-line-id}:
    delete:
      tags:
      - Facility Compliance APIs
      summary: Delete the claim line
      operationId: deleteClaimLine
      parameters:
      - name: claim-line-id
        in: path
        required: true
        schema:
          type: integer
          format: int64
      - 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
components:
  schemas:
    FacilityClaimLine:
      type: object
      properties:
        claimLineId:
          type: integer
          format: int32
        claimId:
          type: integer
          format: int64
        revenueCode:
          type: string
        procedureCode:
          type: string
        modifier:
          type: string
        lineNumber:
          type: integer
          format: int32
        units:
          type: integer
          format: int32
        dateOfService:
          type: string
          format: date-time
        ndc:
          type: string
    FacilityClaimDiag:
      type: object
      properties:
        claimId:
          type: integer
          format: int64
        principalDx:
          type: string
        admitting:
          type: string
        others:
          type: string
        primary1Px:
          type: string
        primary1PxDate:
          type: string
          format: date-time
        primary2Px:
          type: string
        primary2PxDate:
          type: string
          format: date-time
        other1Px:
          type: string
        other1PxDate:
          type: string
          format: date-time
        other2Px:
          type: string
        other2PxDate:
          type: string
          format: date-time
        other3Px:
          type: string
        other3PxDate:
          type: string
          format: date-time
        other4Px:
          type: string
        other4PxDate:
          type: string
          format: date-time
        reasonForVisit:
          type: string
        ipAdmitting:
          type: string
    FacilityClaimUpdate:
      type: object
      properties:
        claimId:
          type: integer
          format: int64
        claimLineId:
          type: integer
          format: int64
        fieldName:
          type: string
        fieldValue:
          type: string
    Code:
      type: object
      properties:
        codeValue:
          type: string
        description:
          type: string
    FacilityClaim:
      type: object
      properties:
        claimId:
          type: integer
          format: int64
        userId:
          type: integer
          format: int64
        currentTimeStamp:
          type: string
          format: date-time
        tabNumber:
          type: integer
          format: int32
        payerType:
          type: integer
          format: int32
        contractorNum:
          type: string
        contractorSort:
          type: string
        medicaidState:
          type: string
        claimIdentifier:
          type: string
        typeOfBill:
          type: string
        statStartDate:
          type: string
          format: date-time
        statEndDate:
          type: string
          format: date-time
        patientDOB:
          type: string
          format: date-time
        patientGender:
          type: string
        patientStatus:
          type: string
        pointOfOrigin:
          type: string
        admissionDate:
          type: string
          format: date-time
        admissionType:
          type: string
        conditionCodes:
          type: string
        valueCodes:
          type: string
        occurrenceCodes:
          type: string
        occurrenceSpanCodes:
          type: string
        complianceType:
          type: integer
          format: int32
        moduleId:
          type: string
        facilityClaimLineList:
          type: array
          items:
            $ref: '#/components/schemas/FacilityClaimLine'
        claimDiag:
          $ref: '#/components/schemas/FacilityClaimDiag'
        claimLineEditsList:
          type: array
          items:
            $ref: '#/components/schemas/FacilityClaimLineEdits'
        payer:
          type: string
    FacilityClaimResponse:
      type: object
      properties:
        claimId:
          type: integer
          format: int64
        patientUserId:
          type: integer
          format: int64
        claimType:
          type: string
          enum:
          - PHYSICIAN
          - FACILITY
        edits:
          type: array
          items:
            $ref: '#/components/schemas/FacilityClaimLineEdits'
    FacilityClaimLineEdits:
      type: object
      properties:
        claimLineId:
          type: integer
          format: int32
        editType:
          type: string
        mnemonic:
          type: string
        message:
          type: string
        claimLineNum:
          type: integer
          format: int32
  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