Optum

Optum prior auth API

The prior auth api API from Optum — 1 operation(s) for prior auth api.

GitHub OpenAPI

Operations 1

POST /abm/priorauth/v1 Prior Auth API Endpoint

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-prior-auth-api-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-prior-auth-api-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  description: PRIORAUTH service is the OI API gateway to fetch priorauth details from ABM. This API needs auth bearer token which can be retrieved using https://sandbox-apigw.optum.com/apip/auth/sntl/v1/token. Please check documentation under Security section to get more details on auth token.
  title: ABM PRIORAUTH API- 1.0.0 prior auth API
  version: 1.0.0
servers:
- url: https://sandbox-apigw.optum.com
tags:
- name: prior auth api
paths:
  /abm/priorauth/v1:
    post:
      requestBody:
        $ref: '#/components/requestBodies/priorauthdata'
      responses:
        '200':
          $ref: '#/components/responses/priorauthdata'
      summary: Prior Auth API Endpoint
      tags:
      - prior auth api
components:
  requestBodies:
    priorauthdata:
      content:
        application/json:
          schema:
            properties:
              dateOfConcern:
                example: 2001/01/01
                type: string
              enterprise:
                example: Enterprise-Name
                type: string
              expectedCols:
                properties:
                  certificationIssueDate:
                    example: 2020/01/01
                    type: string
                  clientName:
                    example: Client Name
                    type: string
                  dependentDob:
                    example: 2002/01/01
                    type: string
                  dependentFirstName:
                    example: EFG
                    type: string
                  dependentIdNum:
                    example: '02'
                    type: string
                  paActionOutcomeCode:
                    example: A
                    type: string
                  paEndDate:
                    example: 2020/01/31
                    type: string
                  paStartDate:
                    example: 2020/01/01
                    type: string
                  payerId:
                    example: 9060
                    type: integer
                  priorAuthNum:
                    example: PA101
                    type: string
                  procModifier1:
                    example: '13'
                    type: string
                  procModifier2:
                    example: ''
                    type: string
                  procModifier3:
                    example: ''
                    type: string
                  procModifier4:
                    example: ''
                    type: string
                  profProcedureCode:
                    example: T10293
                    type: string
                  profUnitApprovedCount:
                    example: '1'
                    type: integer
                  profUnitDeniedCount:
                    example: 1
                    type: integer
                  profUnitRemainingCount:
                    example: 1
                    type: integer
                  profUnitRequestedCount:
                    example: 2
                    type: integer
                  provNpi:
                    example: '25252'
                    type: string
                  provZipCode:
                    example: 123V45
                    type: string
                  serviceLineAmount:
                    example: 10.5
                    type: string
                  subscriberDob:
                    example: 2001/01/01
                    type: string
                  subscriberFirstName:
                    example: ABC
                    type: string
                  subscriberIdNum:
                    example: '92929244'
                    type: string
                  subscriberLastOrgName:
                    example: XYZ
                    type: string
                  vendorId:
                    example: 2
                    type: integer
                  vendorZcodeField:
                    example: Z20203
                    type: string
                type: object
              look_up:
                example: Prior-Auth
                type: string
              params:
                properties:
                  memberId:
                    example: M0000058
                    type: string
                  payerId:
                    example: '9060'
                    type: string
                  vendorId:
                    example: '2'
                    type: string
                type: object
              ruleSet:
                example: 1
                type: integer
            type: object
      description: payload for priorauthdata API
      required: true
  responses:
    priorauthdata:
      content:
        application/json:
          schema:
            properties:
              error:
                example: null
                type: object
              errorDetails:
                example: null
                type: object
              results:
                items:
                  properties:
                    certificationIssueDate:
                      example: 2020/01/01
                      type: string
                    clientName:
                      example: Client Name
                      type: string
                    dependentDob:
                      example: 2002/01/01
                      type: string
                    dependentFirstName:
                      example: EFG
                      type: string
                    dependentIdNum:
                      example: '02'
                      type: string
                    paActionOutcomeCode:
                      example: A
                      type: string
                    paEndDate:
                      example: 2020/01/31
                      type: string
                    paStartDate:
                      example: 2020/01/01
                      type: string
                    payerId:
                      example: 9060
                      type: integer
                    priorAuthNum:
                      example: PA101
                      type: string
                    procModifier1:
                      example: '13'
                      type: string
                    procModifier2:
                      example: ''
                      type: string
                    procModifier3:
                      example: ''
                      type: string
                    procModifier4:
                      example: ''
                      type: string
                    profProcedureCode:
                      example: T10293
                      type: string
                    profUnitApprovedCount:
                      example: '1'
                      type: integer
                    profUnitDeniedCount:
                      example: 1
                      type: integer
                    profUnitRemainingCount:
                      example: 1
                      type: integer
                    profUnitRequestedCount:
                      example: 2
                      type: integer
                    provNpi:
                      example: '25252'
                      type: string
                    provZipCode:
                      example: 123V45
                      type: string
                    serviceLineAmount:
                      example: 10.5
                      type: number
                    subscriberDob:
                      example: 2001/01/01
                      type: string
                    subscriberFirstName:
                      example: ABC
                      type: string
                    subscriberIdNum:
                      example: '92929244'
                      type: string
                    subscriberLastOrgName:
                      example: XYZ
                      type: string
                    vendorId:
                      example: 2
                      type: integer
                    vendorZcodeField:
                      example: Z20203
                      type: string
                type: array
            type: object
      description: response for priorauthdata API
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