Optum

Optum Policy Lookup APIs API

The Policy Lookup APIs API from Optum — 4 operation(s) for policy lookup apis.

Documentation GitHub OpenAPI

Operations 4

POST /api/cms/common/policy-lookup/ Fetches all the policies of a given policy type and given code and/or term #

GET /app/cms/common/policy-lookup/{policy-id}/related-articles Fetches LCD related articles of a given LCD policy id #

GET /api/cms/common/policy-lookup/{policy-type}/{policy-number} Fetches all the policies of a given policy type and policy id #

GET /api/cms/common/medicare-contractors Fetches medicare contractors list for a given contractor part. #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum Policy Lookup APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged Policy Lookup APIs across 2 of this provider''s published API definitions: optum-cms-common-facility-openapi.yml, optum-cms-common-physician-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: /v1/cmscommonms
tags:
- name: Policy Lookup APIs
paths:
  /api/cms/common/policy-lookup/:
    post:
      tags:
      - Policy Lookup APIs
      summary: Fetches all the policies of a given policy type and given code and/or term
      operationId: searchPolicyLookup
      parameters:
      - name: sort
        in: query
        description: Any of these (contractorType,-contractorType,serviceAreas,-serviceAreas) are allowed values, default is -contractorType
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - contractorType
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - 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/PolicySearchRequest'
      responses:
        '200':
          description: 'POST-for-GET - Search Policy Lookup '
          content:
            application/json:
              example:
                content:
                - icpContractorId: 176
                  icpPolicyId: 535110
                  determinationNum: A59355
                  contractorType: MA
                  contractorName: CGS Administrators, LLC
                  policyType: LCD
                  cms: A59355
                  policyTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation and Infection'
                  effectiveDate: '2023-06-29'
                  url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59355&ver=6&bc=0
                  serviceAreas: KY
                  contractorNum: '15101'
                  hasArticles: '0'
                  displayName: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation and Infection'
                  scrubbedTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation and Infection'
                  contractorServiceAreas: 15101 - CGS Administrators, LLC (KY)
                  contractorTypeDisplayName: Part A - FI
                - icpContractorId: 177
                  icpPolicyId: 535111
                  determinationNum: A59355
                  contractorType: MA
                  contractorName: CGS Administrators, LLC
                  policyType: LCD
                  cms: A59355
                  policyTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation and Infection'
                  effectiveDate: '2023-06-29'
                  url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59355&ver=6&bc=0
                  serviceAreas: OH
                  contractorNum: '15201'
                  hasArticles: '0'
                  displayName: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation and Infection'
                  scrubbedTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation and Infection'
                  contractorServiceAreas: 15201 - CGS Administrators, LLC (OH)
                  contractorTypeDisplayName: Part A - FI
                totalCount: 2
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/common/policy-lookuppp
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/common/policy-lookup
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /app/cms/common/policy-lookup/{policy-id}/related-articles:
    get:
      tags:
      - Policy Lookup APIs
      summary: Fetches LCD related articles of a given LCD policy id
      operationId: fetchRelatedLCDPolicyByPolicyById
      parameters:
      - name: policy-id
        in: path
        description: Policy Id
        required: true
        schema:
          type: string
        example: 497873
      - 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/PolicyValue'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/common/policy-lookup/{policy-type}/{policy-number}:
    get:
      tags:
      - Policy Lookup APIs
      summary: Fetches all the policies of a given policy type and policy id
      operationId: fetchPolicyByIdValue
      parameters:
      - name: sort
        in: query
        description: Any of these (contractorType,-contractorType,serviceAreas,-serviceAreas) are allowed values, default is -contractorType
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - contractorType
      - name: policy-type
        in: path
        description: Policy Number
        required: true
        schema:
          type: string
          enum:
          - NCD_PART_A
          - NCD_PART_B
          - LCD_DME
          - NCD_DME
          - LCD_PART_A
          - LCD_PART_B
          - NCD_LAB
        example: LCD
      - name: policy-number
        in: path
        description: Policy Number
        required: true
        schema:
          type: string
        example: L39314
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - 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: Search Policies by policy Id
          content:
            application/json:
              example:
                content:
                - icpContractorId: 222
                  icpPolicyId: 532655
                  determinationNum: L39314
                  contractorType: MB
                  contractorName: National Government Services, Inc.
                  policyType: LCD
                  cms: L39314
                  policyTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
                  effectiveDate: '2022-11-01'
                  url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39314&ver=7&bc=0
                  serviceAreas: IL
                  contractorNum: '06102'
                  hasArticles: '2'
                  displayName: Off-Label Use of Intravenous Immune Globulin (IVIG)
                  scrubbedTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
                  contractorServiceAreas: 06102 - National Government Services, Inc. (IL)
                  contractorTypeDisplayName: Part B
                - icpContractorId: 223
                  icpPolicyId: 532656
                  determinationNum: L39314
                  contractorType: MB
                  contractorName: National Government Services, Inc.
                  policyType: LCD
                  cms: L39314
                  policyTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
                  effectiveDate: '2022-11-01'
                  url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39314&ver=7&bc=0
                  serviceAreas: MN
                  contractorNum: '06202'
                  hasArticles: '2'
                  displayName: Off-Label Use of Intravenous Immune Globulin (IVIG)
                  scrubbedTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
                  contractorServiceAreas: 06202 - National Government Services, Inc. (MN)
                  contractorTypeDisplayName: Part B
                totalCount: 22
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/common/policy-lookupp/L39313
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/common/policy-lookup
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/common/medicare-contractors:
    get:
      tags:
      - Policy Lookup APIs
      summary: Fetches medicare contractors list for a given contractor part.
      operationId: fetchMedicareContractors
      parameters:
      - name: contractor-part
        in: query
        description: Any of these contractor parts (A or B or DME) are allowed, default is A.
        required: false
        schema:
          type: string
          enum:
          - A
          - B
          - DME
        example: A
      - 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/ContractorValue'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
components:
  schemas:
    PolicyValue:
      type: object
      properties:
        icpContractorId:
          type: integer
          format: int64
        icpPolicyId:
          type: integer
          format: int64
        determinationNum:
          type: string
        contractorType:
          type: string
        contractorName:
          type: string
        policyType:
          type: string
        cms:
          type: string
        policyTitle:
          type: string
        effectiveDate:
          type: string
          format: date-time
        expirationDate:
          type: string
          format: date-time
        url:
          type: string
        contractorURL:
          type: string
        activeRetiredStatus:
          type: string
        serviceAreas:
          type: string
        contractorNum:
          type: string
        hasArticles:
          type: string
        titleShort:
          type: string
        userDefinedEffectiveDate:
          type: string
        scrubbedTitle:
          type: string
        displayName:
          type: string
        contractorServiceAreas:
          type: string
        contractorTypeDisplayName:
          type: string
    Notification:
      type: object
      properties:
        error:
          type: array
          items:
            type: string
        warning:
          type: array
          items:
            type: string
        info:
          type: array
          items:
            type: string
    Lcd:
      type: object
      properties:
        carrierId:
          type: integer
          format: int32
        fiId:
          type: integer
          format: int32
        dmeId:
          type: integer
          format: int32
        retiredPolicies:
          type: boolean
    ContractorValue:
      type: object
      properties:
        contractorNum:
          type: string
        stateAbbr:
          type: string
        contractorName:
          type: string
        regionCode:
          type: string
        contractorType:
          type: string
        url:
          type: string
        contractorEid:
          type: string
        icpContractorId:
          type: string
    DiagnosisCode:
      type: object
      properties:
        code:
          type: string
        codeType:
          type: string
    TermSearch:
      type: object
      properties:
        keyword:
          type: string
        searchBy:
          type: string
        searchLogic:
          type: string
    PolicySearchRequest:
      type: object
      properties:
        policyType:
          type: string
          enum:
          - NCD_PART_A
          - NCD_PART_B
          - LCD_DME
          - NCD_DME
          - LCD_PART_A
          - LCD_PART_B
          - NCD_LAB
        searchType:
          type: string
        procedureCode:
          type: string
        termSearch:
          $ref: '#/components/schemas/TermSearch'
        diagnosisCode:
          $ref: '#/components/schemas/DiagnosisCode'
        effectiveDate:
          type: string
          format: date-time
        lcd:
          $ref: '#/components/schemas/Lcd'
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-refined-from:
- optum-cms-common-facility-openapi.yml
- optum-cms-common-physician-openapi.yml
x-readme:
  explorer-enabled: true
  proxy-enabled: true