Optum

Optum Payersheet API

API to process Payersheet information

GitHub OpenAPI
Business capability
Claim Production & Submission BC-2870.30

Operations 3

POST /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/fetch Fetch Claim Format #
POST /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/save Save Claim Format #
PATCH /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/update Update Claim Format #

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-payersheet-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-payersheet-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  description: API for Formatting Rule
  title: Formatting Rule Payersheet API
  version: v1
servers:
- description: Generated server url
  url: https://sandbox-apigw.optum.com/rxn/formattingrules
security:
- oauth2_security: []
tags:
- description: API to process Payersheet information
  name: Payersheet
paths:
  /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/fetch:
    post:
      description: This endpoint is used to retrieve existing telecom claim formats based on provided criteria (e.g., payer ID, format ID, etc.). It returns the matching claim format(s) from the system for viewing or further processing.
      operationId: getClaimFormat
      requestBody:
        content:
          application/json:
            schema:
              properties:
                getClaimFormatRequest:
                  $ref: '#/components/schemas/GetClaimFormatRequest'
              type: object
        required: true
      responses:
        '200':
          content:
            '*/*':
              schema:
                properties:
                  getClaimFormatResponse:
                    $ref: '#/components/schemas/GetClaimFormatResponse'
                type: object
          description: OK
      summary: Fetch Claim Format
      tags:
      - Payersheet
  /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/save:
    post:
      description: This endpoint is used to save a new telecom claim format. It accepts a payload containing the details of the claim format and persists it in the system. Typically used when creating a new configuration for telecom-based payer sheets.
      operationId: saveClaimFormat
      parameters:
      - in: query
        name: request
        required: true
        schema:
          properties:
            saveClaimFormatRequest:
              $ref: '#/components/schemas/SaveClaimFormatRequest'
          type: object
      responses:
        '200':
          content:
            '*/*':
              schema:
                type: string
          description: OK
      summary: Save Claim Format
      tags:
      - Payersheet
  /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/update:
    patch:
      description: This endpoint is used to update an existing telecom claim format. It requires the updated format data, including the identifier of the format to be modified. Useful for maintaining or correcting claim format configurations.
      operationId: updateClaimFormat
      parameters:
      - in: query
        name: request
        required: true
        schema:
          properties:
            updateClaimFormatRequest:
              $ref: '#/components/schemas/UpdateClaimFormatRequest'
          type: object
      responses:
        '200':
          content:
            '*/*':
              schema:
                type: string
          description: OK
      summary: Update Claim Format
      tags:
      - Payersheet
components:
  schemas:
    JsonClaimFormat:
      properties:
        billingSequence:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 2
          example: S1
        bin:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 6
          example: A99
        chainID:
          type: string
          pattern: ^[0-9]*$
          maxLength: 38
        code:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: DG6
        customer:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 128
          example: customerName
        description:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: NCPDP D.0 Claim
        effectiveDate:
          type: string
          format: rxn-date
          example: '2025-01-01'
        expirationDate:
          type: string
          format: rxn-date
          example: '2030-01-01'
        externalMessageId:
          type: string
          pattern: ^[0-9]*$
        groupCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 15
          example: D0
        pcn:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: A987
        rems:
          type: string
          maxLength: 1
          example: N
          enum:
          - y
          - n
          - Y
          - N
          - null
        siteCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 80
          example: epsxx92qax1e2cz
        sourceSystemId:
          type: string
          pattern: ^[0-9]*$
        transmissions:
          items:
            $ref: '#/components/schemas/JsonTransmission'
          type: array
      type: object
    GetClaimFormatResponse:
      properties:
        claimFormat:
          $ref: '#/components/schemas/JsonClaimFormat'
      type: object
    GetClaimFormatRequest:
      properties:
        billingSequence:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 2
          example: S1
        bin:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 6
          example: A99
        chainID:
          type: string
          pattern: ^[0-9]*$
          maxLength: 38
        code:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: DG6
        customer:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 128
          example: customerName
        externalMessageId:
          type: string
          pattern: ^[0-9]*$
        groupCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 15
          example: D0
        pcn:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: A987
        rems:
          type: string
          maxLength: 1
          example: N
          enum:
          - y
          - n
          - Y
          - N
          - null
        siteCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 80
          example: epsxx92qax1e2cz
        sourceSystemId:
          type: string
          pattern: ^[0-9]*$
        transactionCode:
          type: string
      type: object
    UpdateClaimFormatRequest:
      properties:
        claimFormat:
          $ref: '#/components/schemas/JsonClaimFormat'
      type: object
    SaveClaimFormatRequest:
      properties:
        claimFormat:
          $ref: '#/components/schemas/JsonClaimFormat'
      type: object
    JsonFieldGroup:
      properties:
        fieldGroupId:
          format: int64
          type: integer
        fieldIdentifier:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: '123'
        fieldNumber:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 4
          example: A1
        groupCode:
          type: string
        maximumCount:
          type: string
          example: '10'
      type: object
    JsonSegment:
      properties:
        segmentFields:
          items:
            $ref: '#/components/schemas/JsonSegmentField'
          type: array
        segmentIdentifier:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 32
          example: HEADER
        sequence:
          format: int32
          type: integer
          example: '2'
        usageCode:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: M
      type: object
    JsonSegmentField:
      properties:
        customName:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: custom field name
        customProcessingCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 10
          example: A1
        description:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: field description
        fieldDataType:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: Integer
        fieldDataTypeId:
          format: int64
          type: integer
          example: '1'
        fieldGroups:
          items:
            $ref: '#/components/schemas/JsonFieldGroup'
          type: array
          example: []
        fieldIdentifier:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: A1
        fieldNumber:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 4
          example: '101'
        fieldType:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 1
          example: I
        includeIfNull:
          type: boolean
          example: 'true'
        mantissaSize:
          format: int32
          type: integer
          example: '1'
        maximumLength:
          format: int32
          type: integer
          example: '10'
        segmentFieldQualifiers:
          items:
            $ref: '#/components/schemas/JsonSegmentFieldQualifier'
          type: array
          example: []
        sequence:
          format: int32
          type: integer
          example: '1'
        usageCode:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: M
        useIfNull:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: '   '
      type: object
    JsonTransmission:
      properties:
        code:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 10
          example: B1
        segments:
          items:
            $ref: '#/components/schemas/JsonSegment'
          type: array
        standard:
          type: string
          maxLength: 2
          example: D0
          enum:
          - D0
          - ''
        type:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 50
          example: request
      type: object
    JsonSegmentFieldQualifier:
      properties:
        qualifierCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 10
        qualifierDescription:
          type: string
          maxLength: 250
        sequence:
          format: int32
          type: integer
      type: object
  securitySchemes:
    oauth2_security:
      flows:
        clientCredentials:
          scopes: {}
          tokenUrl: https://idx-stage.linkhealth.com/auth/realms/developer-platform/protocol/openid-connect/token
      type: oauth2
externalDocs:
  description: Resource Docs
  url: https://springdoc.org/
x-readme:
  explorer-enabled: true
  proxy-enabled: true