Optum

Optum Noa API

The Noa API from Optum — 2 operation(s) for noa.

Documentation GitHub OpenAPI

Operations 2

POST /noa/x12 278x216 Prior Authorization Notice Of Admission

POST /noa JSON Notice of Admission

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Prior Authorization v1 Noa API
  description: ''
  version: 1.1.0
  contact:
    email: ''
servers:
- url: https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/
- url: /processor
security:
- bearerAuth: []
tags:
- name: Noa
paths:
  /noa/x12:
    post:
      summary: 278x216 Prior Authorization Notice Of Admission
      description: Prior authorization noa using EDI X12 278x216 requests
      tags:
      - Noa
      parameters:
      - $ref: '#/components/parameters/x-optum-tenant-id'
      - $ref: '#/components/parameters/x-optum-correlation-id'
      requestBody:
        description: Authorization Noa request
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/NoaX12Request'
      responses:
        '200':
          description: Success
          headers:
            x-amzn-trace-id:
              $ref: '#/components/headers/x-amzn-trace-id'
            transaction-id:
              $ref: '#/components/headers/transaction-id'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/NoaResponse'
              examples:
                subscriber:
                  $ref: '#/components/examples/UserNoaResponse'
        '400':
          $ref: '#/components/responses/400'
        '401':
          $ref: '#/components/responses/401'
        '403':
          $ref: '#/components/responses/403'
        '500':
          $ref: '#/components/responses/500'
  /noa:
    post:
      summary: JSON Notice of Admission
      description: Prior authorization notice of admission using JSON requests
      tags:
      - Noa
      parameters:
      - $ref: '#/components/parameters/x-optum-tenant-id'
      - $ref: '#/components/parameters/x-optum-correlation-id'
      requestBody:
        description: Authorization notice of admission request
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/AuthorizationNoaJSON'
            examples:
              subscriber:
                $ref: '#/components/examples/UserNoaRequest'
      responses:
        '200':
          description: Success
          headers:
            x-amzn-trace-id:
              $ref: '#/components/headers/x-amzn-trace-id'
            transaction-id:
              $ref: '#/components/headers/transaction-id'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/NoaResponse'
              examples:
                subscriber:
                  $ref: '#/components/examples/UserNoaResponse'
        '400':
          $ref: '#/components/responses/400'
        '401':
          $ref: '#/components/responses/401'
        '403':
          $ref: '#/components/responses/403'
        '500':
          $ref: '#/components/responses/500'
components:
  examples:
    UserNoaRequest:
      summary: Notice of admission Request (JSON)
      value:
        senderId: 201985AAS
        submitterTransactionIdentifier: 222438911WEB
        payerId: '60054'
        payerName: AETNA
        umClearingHouseId: IMNDIRECT
        source:
          sourceType: FA
          organizationName: B'enefits Health System'
          lastName: Benefits Health System
          npi: '1881650737'
          contactTelephone: '4064552959'
        subscriber:
          lastName: LNAME
          firstName: FNAME
          memberId: NOA-01-SUCCESS
          supplementalIdentification:
            groupNumber: 0123456789012
          dateOfBirth: '19700101'
        patientEventDetail:
          requestCategoryCode: AR
          certificationTypeCode: I
          serviceTypeCode: '1'
          facilityTypeCode: '11'
          facilityCodeQualifier: A
          accidentDate: '20260101'
          lastMenstrualPeriodDate: '20260101'
          estimatedDateOfBirth: '20260101'
          onsetDate: '20260101'
          eventDateBegin: '20260101'
          admissionDateBegin: '20260101'
          admissionDateEnd: '20260101'
          dischargeDate: '20260101'
          certificationIssueDateBegin: '20260101'
          certificationExpirationDateBegin: '20260101'
          certificationEffectiveDateBegin: '20260101'
          diagnosisTypeCode1: ABJ
          diagnosisCode1: N1330
          freeFormMessageText: AT=061500;ICD=N1330
          patientEventProviderName:
          - entityIdentifierCode: '71'
            organizationName: Benefits Health System
            lastName: SLATER
            firstName: RICHARD
            identificationCodeQualifier: XX
            identifier: '1285928754'
    UserNoaResponse:
      summary: Noa Response Subscriber Only
      value:
        authorizationId: 16665bb7-3040-4d4d-a889-123a27b29789
        noa:
          x12: ISA*00*6666      *00*5555      *ZZ*6546564        *ZZ*6546564        *0623  *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X216~ST*278*0001*005010X216~BHT*0007*11*165932*20055002*0815*18~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~
          json:
            submitterTransactionIdentifier: '165932'
            payerId: '1234560010'
            payerName: ABC PAYER
            umClearingHouseId: PERSEPVS
            umRequestValidation: null
            requester:
              requesterType: 1P
              lastName: XYZ AMBULANCE SVC
              requesterIdentification: {}
              employersId: '7759621873'
            subscriber:
              lastName: SMITH
              firstName: JOE
              memberId: '12345689001'
              dateOfBirth: '19700101'
              genderCode: M
              supplementalIdentification:
                patientAccountNumber: '1234567890'
            dependent:
              supplementalIdentification: {}
            patientEventDetail:
              requestCategoryCode: HS
              certificationTypeCode: I
              serviceTypeCode: '56'
              facilityTypeCode: '41'
              facilityCodeQualifier: B
              certificationActionCode: A1
              reviewIdentificationNumber: '1234567890123'
              eventDateBegin: '20250101'
              ambulanceTransportCode: X
              ambulanceUnitOrBasisForMeasurementCode: DH
              ambulanceTransportDistance: '27'
              patientEventAdditionalPatientInformationContactName:
              - {}
              patientEventTransportInformation:
              - entityIdentifierCode: PW
                transportLocationName: HOME
                address1: 123 SOME ROAD
                city: SACRAMENTO
                state: CA
                postalCode: '95826'
              - entityIdentifierCode: ND
                transportLocationName: DOCTOR OFFICE
                address1: 123 SOME AVENUE
                city: SACRAMENTO
                state: CA
                postalCode: '95624'
              - entityIdentifierCode: R3
                transportLocationName: SOME DIALYSIS CENTER
                address1: 123 SOME ROAD
                city: SACRAMENTO
                state: CA
                postalCode: '95826'
              - entityIdentifierCode: FS
                transportLocationName: HOME
                address1: 123 SOME ROAD
                city: SACRAMENTO
                state: CA
                postalCode: '95826'
              serviceLevel:
              - professionalService:
                  productOrServiceIDQualifier: HC
                  procedureCode: A0428
                  procedureModifier: RX
                  unitOrBasisForMeasurementCode: UN
                  serviceUnitCount: '5'
                institutionalService: {}
                dentalService: {}
                serviceDetailAdditionalServiceInformationContactName:
                - {}
              - professionalService:
                  productOrServiceIDQualifier: HC
                  procedureCode: A0428
                  procedureModifier: PD
                  unitOrBasisForMeasurementCode: UN
                  serviceUnitCount: '8'
                institutionalService: {}
                dentalService: {}
                serviceDetailAdditionalServiceInformationContactName:
                - {}
              - professionalService:
                  productOrServiceIDQualifier: HC
                  procedureCode: A0428
                  procedureModifier: DR
                  unitOrBasisForMeasurementCode: UN
                  serviceUnitCount: '14'
                institutionalService: {}
                dentalService: {}
                serviceDetailAdditionalServiceInformationContactName:
                - {}
  schemas:
    NoaX12Request:
      type: object
      properties:
        x12:
          type: string
          description: EDI X12 278x216 Request
          example: ISA*00*          *00*          *ZZ*83825418A      *ZZ*IMNDIRECT      *260203*0815*^*00501*375720525*0*P*:~GS*HI*LRX1210001*MTEXE*20260203*0815*1234*X*005010X216~ST*278*0001*005010X216~BHT*0007*CN*222438911WEB*20260203*0815*NO~HL*1**20*1~NM1*FA*2*Benefis Health System*****XX*1881650737~PER*IC**TE*4064552959~HL*2*1*21*1~NM1*X3*2*AETNA*****PI*60054~HL*3*2*22*1~NM1*IL*1*LNAME*FNAME****MI*NOA-01-SUCCESS~REF*6P*0123456789012~DMG*D8*19700101~HL*4*3*EV*1~UM*AR*I*1*11:A~DTP*435*D8*20260101~HI*ABJ:N1330~MSG*AT=061500;ICD=N1330~NM1*71*1*SLATER*RICHARD****XX*1285928754~NM1*FA*2*Benefis Health System*****XX*1881650737~NM1*AAJ*1*SLATER*RICHARD****XX*1285928754~SE*20*0001~GE*1*1234~IEA*1*375720525~
    Errors:
      type: array
      items:
        type: string
        example: This is an example error string
    AuthorizationNoaJSON:
      type: object
      properties:
        senderId:
          type: string
        submitterTransactionIdentifier:
          type: string
        payerId:
          type: string
        payerName:
          type: string
        umClearingHouseId:
          type: string
        requester:
          type: object
          properties:
            requesterType:
              type: string
            organizationName:
              type: string
            lastName:
              type: string
            firstName:
              type: string
            requesterIdentification:
              type: object
              properties:
                providerUpinNumber:
                  type: string
                facilityIdNumber:
                  type: string
                employerIdentificationNumber:
                  type: string
                providerSiteNumber:
                  type: string
                providerPlanNetworkIdNumber:
                  type: string
                facilityNetworkIdNumber:
                  type: string
                socialSecurityNumber:
                  type: string
                carrierAssignedReferenceNumber:
                  type: string
            address1:
              type: string
            address2:
              type: string
            city:
              type: string
            state:
              type: string
            postalCode:
              type: string
            countryCode:
              type: string
            countrySubDivisionCode:
              type: string
            npi:
              type: string
            ssn:
              type: string
            servicesPlanID:
              type: string
            employersId:
              type: string
            etin:
              type: string
            contactName:
              type: string
            contactElectronicMail:
              type: string
            contactFacsimile:
              type: string
            contactTelephone:
              type: string
            contactTelephoneExtension:
              type: string
            providerCode:
              type: string
            referenceIdentification:
              type: string
        subscriber:
          type: object
          properties:
            lastName:
              type: string
            firstName:
              type: string
            middleName:
              type: string
            suffix:
              type: string
            memberId:
              type: string
            dateOfBirth:
              type: string
            genderCode:
              type: string
            supplementalIdentification:
              type: object
              properties:
                policyNumber:
                  type: string
                branchIdentifier:
                  type: string
                groupNumber:
                  type: string
                departmentNumber:
                  type: string
                patientAccountNumber:
                  type: string
                healthInsuranceClaimNumber:
                  type: string
                idCard:
                  type: string
                insurancePolicyNumber:
                  type: string
                planNetworkIdentificationNumber:
                  type: string
                medicaidRecipientIdentificationNumber:
                  type: string
                ssn:
                  type: string
            address1:
              type: string
            address2:
              type: string
            city:
              type: string
            state:
              type: string
            postalCode:
              type: string
            countryCode:
              type: string
            countrySubDivisionCode:
              type: string
            insuredIndicator:
              type: string
            militaryRelationship:
              type: string
        dependent:
          type: object
          properties:
            lastName:
              type: string
            firstName:
              type: string
            middleName:
              type: string
            suffix:
              type: string
            dateOfBirth:
              type: string
            genderCode:
              type: string
            supplementalIdentification:
              type: object
              properties:
                patientAccountNumber:
                  type: string
                ssn:
                  type: string
            address1:
              type: string
            address2:
              type: string
            city:
              type: string
            state:
              type: string
            postalCode:
              type: string
            countryCode:
              type: string
            countrySubDivisionCode:
              type: string
            insuredIndicator:
              type: string
            relationshipToInsuredCode:
              type: string
            birthSequenceNumber:
              type: string
        patientEventDetail:
          type: object
          properties:
            requestCategoryCode:
              type: string
            certificationTypeCode:
              type: string
            serviceTypeCode:
              type: string
            facilityTypeCode:
              type: string
            facilityCodeQualifier:
              type: string
            relatedCausesCode1:
              type: string
            relatedCausesCode2:
              type: string
            relatedCausesCode3:
              type: string
            stateCode:
              type: string
            countryCode:
              type: string
            levelOfServiceCode:
              type: string
            currentHealthConditionCode:
              type: string
            prognosisCode:
              type: string
            releaseOfInformationCode:
              type: string
            delayReasonCode:
              type: string
            previousReviewAuthorizationNumber:
              type: string
            previousAdministrativeReferenceNumber:
              type: string
            accidentDate:
              type: string
            lastMenstrualPeriodDate:
              type: string
            estimatedDateOfBirth:
              type: string
            onsetDate:
              type: string
            eventDateBegin:
              type: string
            eventDateEnd:
              type: string
            admissionDateBegin:
              type: string
            admissionDateEnd:
              type: string
            dischargeDate:
              type: string
            diagnosisTypeCode1:
              type: string
            diagnosisCode1:
              type: string
            diagnosisDate1:
              type: string
            diagnosisTypeCode2:
              type: string
            diagnosisCode2:
              type: string
            diagnosisDate2:
              type: string
            diagnosisTypeCode3:
              type: string
            diagnosisCode3:
              type: string
            diagnosisDate3:
              type: string
            diagnosisTypeCode4:
              type: string
            diagnosisCode4:
              type: string
            diagnosisDate4:
              type: string
            diagnosisTypeCode5:
              type: string
            diagnosisCode5:
              type: string
            diagnosisDate5:
              type: string
            diagnosisTypeCode6:
              type: string
            diagnosisCode6:
              type: string
            diagnosisDate6:
              type: string
            diagnosisTypeCode7:
              type: string
            diagnosisCode7:
              type: string
            diagnosisDate7:
              type: string
            diagnosisTypeCode8:
              type: string
            diagnosisCode8:
              type: string
            diagnosisDate8:
              type: string
            diagnosisTypeCode9:
              type: string
            diagnosisCode9:
              type: string
            diagnosisDate9:
              type: string
            diagnosisTypeCode10:
              type: string
            diagnosisCode10:
              type: string
            diagnosisDate10:
              type: string
            diagnosisTypeCode11:
              type: string
            diagnosisCode11:
              type: string
            diagnosisDate11:
              type: string
            diagnosisTypeCode12:
              type: string
            diagnosisCode12:
              type: string
            diagnosisDate12:
              type: string
            quantityQualifier:
              type: string
            serviceUnitCount:
              type: string
            unitOrBasisForMeasurementCode:
              type: string
            sampleSelectionModulus:
              type: string
            timePeriodQualifier:
              type: string
            periodCount:
              type: string
            deliveryFrequencyCode:
              type: string
            deliveryPatternTimeCode:
              type: string
            ambulanceCertificationConditionIndicator:
              type: string
            ambulanceCertificationConditionCode1:
              type: string
            ambulanceCertificationConditionCode2:
              type: string
            ambulanceCertificationConditionCode3:
              type: string
            ambulanceCertificationConditionCode4:
              type: string
            ambulanceCertificationConditionCode5:
              type: string
            chiropracticCertificationConditionIndicator:
              type: string
            chiropracticCertificationConditionCode1:
              type: string
            chiropracticCertificationConditionCode2:
              type: string
            chiropracticCertificationConditionCode3:
              type: string
            chiropracticCertificationConditionCode4:
              type: string
            chiropracticCertificationConditionCode5:
              type: string
            durableMedicalEquipmentCertificationConditionIndicator:
              type: string
            durableMedicalEquipmentCertificationConditionCode1:
              type: string
            durableMedicalEquipmentCertificationConditionCode2:
              type: string
            durableMedicalEquipmentCertificationConditionCode3:
              type: string
            durableMedicalEquipmentCertificationConditionCode4:
              type: string
            durableMedicalEquipmentCertificationConditionCode5:
              type: string
            oxygenTherapyCertificationConditionIndicator:
              type: string
            oxygenTherapyCertificationConditionCode1:
              type: string
            oxygenTherapyCertificationConditionCode2:
              type: string
            oxygenTherapyCertificationConditionCode3:
              type: string
            oxygenTherapyCertificationConditionCode4:
              type: string
            oxygenTherapyCertificationConditionCode5:
              type: string
            functionalLimitationsCertificationConditionIndicator:
              type: string
            functionalLimitationsCertificationConditionCode1:
              type: string
            functionalLimitationsCertificationConditionCode2:
              type: string
            functionalLimitationsCertificationConditionCode3:
              type: string
            functionalLimitationsCertificationConditionCode4:
              type: string
            functionalLimitationsCertificationConditionCode5:
              type: string
            activitiesPermittedCertificationConditionIndicator:
              type: string
            activitiesPermittedCertificationConditionCode1:
              type: string
            activitiesPermittedCertificationConditionCode2:
              type: string
            activitiesPermittedCertificationConditionCode3:
              type: string
            activitiesPermittedCertificationConditionCode4:
              type: string
            activitiesPermittedCertificationConditionCode5:
              type: string
            mentalStatusCertificationConditionIndicator:
              type: string
            mentalStatusCertificationConditionCode1:
              type: string
            mentalStatusCertificationConditionCode2:
              type: string
            mentalStatusCertificationConditionCode3:
              type: string
            mentalStatusCertificationConditionCode4:
              type: string
            mentalStatusCertificationConditionCode5:
              type: string
            admissionToFacility:
              type: object
              properties:
                admissionTypeCode:
                  type: string
                admissionSourceCode:
                  type: string
                patientStatusCode:
                  type: string
                nursingHomeResidentialStatusCode:
                  type: string
            ambulanceTransport:
              type: object
              properties:
                patientWeight:
                  type: string
                transportCode:
                  type: string
                transportReasonCode:
                  type: string
                transportDistance:
                  type: string
                roundTripPurposeDescription:
                  type: string
                stretcherPurposeDescription:
                  type: string
            spinalManipulation:
              type: object
              properties:
                treatmentSeriesNumber:
                  type: string
                treatmentCount:
                  type: string
                subluxationBeginningLevelCode:
                  type: string
                subluxationEndLevelCode:
                  type: string
                patientConditionCode:
                  type: string
                complicationIndicator:
                  type: string
                patientConditionDescription1:
                  type: string
                patientConditionDescription2:
                  type: string
                xrayAvailabilityIndicator:
                  type: string
            homeOxygenTherapyInformation:
              type: object
              properties:
                equipmentTypeCode1:
                  type: string
                equipmentTypeCode2:
                  type: string
                equipmentTypeCode3:
                  type: string
                equipmentReasonDescription:
                  type: string
                flowRate:
                  type: string
                dailyUseCount:
                  type: string
                usePeriodHourCount:
                  type: string
                respiratoryTherapistOrderText:
                  type: string
                arterialBloodGasQuantity:
                  type: string
                saturationQuantity:
                  type: string
                testConditionCode:
                  type: string
                testFindingsCode1:
                  type: string
                testFindingsCode2:
                  type: string
                testFindingsCode3:
                  type: string
                portableSystemFlowRate:
                  type: string
                deliverySystemCode:
                  type: string
            homeHealth:
              type: object
              properties:
                prognosisCode:
                  type: string
                startDate:
                  type: string
                certificationPeriodStartDate:
                  type: string
                certificationPeriodEndDate:
                  type: string
                medicareCoverageIndicator:
                  type: string
                certificationTypeCode:
                  type: string
                surgeryDate:
                  type: string
                productOrServiceQualifier:
                  type: string
                surgicalProcedureCode:
                  type: string
                physicalOrderDate:
                  type: string
                lastVisitDate:
                  type: string
                physicianContactDate:
                  type: string
                lastAdmissionPeriodStartDate:
                  type: string
                lastAdmissionPeriodEndDate:
                  type: string
                patientLocationCode:
                  type: string
            attachments:
              type: array
              items:
                type: object
                properties:
                  reportTypeCode:
                    type: string
                  transmissionCode:
                    type: string
                  controlNumber:
                    type: string
                  description:
                    type: string
            freeFormMessageText:
              type: string
            patientEventProviderName:
              type: array
              items:
                type: object
                properties:
                  entityIdentifierCode:
                    type: string
                  organizationName:
                    type: string
                  lastName:
                    type: string
                  firstName:
                    type: string
                  middleName:
                    type: string
                  namePrefix:
                    type: string
                  nameSuffix:
                    type: string
                  identificationCodeQualifier:
                    type: string
                  identifier:
                    type: string
                  address1:
                    type: string
                  address2:
                    type: string
                  city:
                    type: string
                  state:
                    type: string
                  postalCode:
                    type: string
                  countryCode:
                    type: string
                  countrySubDivisionCode:
                    type: string
                  providerSupplementalInformation:
                    type: object
                    properties:
                      stateLicenseNumber:
                        type: string
                      licenseNumberStateCode:
                        type: string
                      providerUpinNumber:
                        type: string
                      facilityIdNumber:
                        type: string
                      employersIdentificationNumber:
                        type: string
                      providerPlanNetworkIdentificationNumber:
                        type: string
                      facilityNetworkIdentificationNumber:
                        type: string
                      ssn:
                        type: string
                      carrierAssignedReferenceNumber:
                        type: string
                  contactName:
                    type: string
                  contactElectronicMail:
                    type: string
                  contactFacsimile:
                    type: string
                  contactTelephone:
                    type: string
                  contactTelephoneExtension:
                    type: string
                  providerCode:
                    type: string
                  providerTaxonomyCode:
                    type: string
            patientEventTransportInformation:
              type: array
              items:
                type: object
                properties:
                  entityIdentifierCode:
                    type: string
                  transportLocationName:
                    type: string
                  address1:
                    type: string
                  address2:
                    type: string
                  city:
                    type: string
                  state:
                    type: string
                  postalCode:
                    type: string
            patientEventOtherUmoName:
              type: array
              items:
                type: object
                properties:
                  entityIdentifierCode:
                    type: string
                  otherUmoName:
                    type: string
                  otherUmoDenialReason1:
                    type: string
                  otherUmoDenialReason2:
                    type: string
                  otherUmoDenialReason3:
                    type: string
                  otherUmoDenialReason4:
                    type: string
                  otherUmoDenialDate:
                    type: string
            serviceLevel:
              type: array
              items:
                type: object
                properties:
                  requestCategoryCode:
                    type: string
                  certificationTypeCode:
                    type: string
                  serviceTypeCode:
                    type: string
                  facilityTypeCode:
                    type: string
                  facilityCodeQualifier:
                    type: string
                  previousReviewAuthorizationNumber:
                    type: string
                  previousAdministrativeReferenceNumber:
                    type: string
                  serviceDateBegin:
                    type: string
                  serviceDateEnd:
                    type: string
                  professionalService:
                    type: object
                    properties:
                      productOrServiceIDQualifier:
                        type: string
                      procedureCode:
                        type: string
                      procedureModifier1:
                        type: string
                      procedureModifier2:
                        type: string
                      procedureModifier3:
                        type: string
                      procedureModifier4:
                        type: string
                      procedureCodeDescription:
                        type: string
                      procedureCode2:
                        type: string
                      serviceLineAmount:
                        type: string
                      unitOrBasisForMeasu

# --- truncated at 32 KB (69 KB total) ---
# Full source: https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-noa-api-openapi.yml