Optum

Optum Medical Network Eligibility and Claims API

RESTful, JSON and X12 EDI (270/271, 837, 276/277, 835) healthcare transaction APIs for real-time patient eligibility and coverage verification, professional and institutional claim validation and submission, claim status inquiry, ERA/claim responses and reports, prior authorization, attachments, and payer list lookup.

GitHub

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

Other Resources

🔗
APIsJSON
https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/apis.yml

API entry from apis.yml

apis.yml Raw ↑ 
name: Optum Medical Network Eligibility and Claims API
description: RESTful, JSON and X12 EDI (270/271, 837, 276/277, 835) healthcare transaction APIs for real-time
  patient eligibility and coverage verification, professional and institutional claim validation and submission,
  claim status inquiry, ERA/claim responses and reports, prior authorization, attachments, and payer list
  lookup.
humanURL: https://developer.optum.com/eligibilityandclaims
baseURL: https://apigw.optum.com/medicalnetwork/
tags:
- Eligibility
- Claims
- Claim Status
- ERA
- Prior Authorization
- X12
properties:
- type: APIReference
  url: https://developer.optum.com/eligibilityandclaims/reference/api-overview
- type: GettingStarted
  url: https://developer.optum.com/eligibilityandclaims/docs/get-started-with-optum-api
- type: Authentication
  url: https://developer.optum.com/eligibilityandclaims/docs/optum-security-and-authorization