Optum Professional Claims API

openapi: 3.2.0
info:
  title: Medical Network V3 Professional Claims API
  description: 835 Professional Claims
  version: V3
servers:
- url: https://sandbox-apigw.optum.com
  description: Optum
tags:
- name: Professional Claims
  description: Professional Claims
paths:
  /medicalnetwork/professionalclaims/v3/validation:
    post:
      tags:
      - Professional Claims
      summary: Claim Validation
      operationId: validateClaim
      parameters:
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ClaimSubmissionRequest'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/professionalclaims/v3/submission:
    post:
      tags:
      - Professional Claims
      summary: Claim Submission
      operationId: processClaim
      parameters:
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ClaimSubmissionRequest'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/professionalclaims/v3/raw-x12-submission:
    post:
      tags:
      - Professional Claims
      summary: Claim Submission x12
      operationId: rawX12Submission
      parameters:
      - name: X-CHC-ClaimSubmission-BillerId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Username
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Pwd
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-SubmitterId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-TraceId
        in: header
        required: false
        schema:
          type: string
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/RawX12Request'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/professionalclaims/v3/raw-x12-validation:
    post:
      tags:
      - Professional Claims
      summary: Claim Validation x12
      operationId: rawX12Validation
      parameters:
      - name: X-CHC-ClaimSubmission-BillerId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Username
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Pwd
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-SubmitterId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-TraceId
        in: header
        required: false
        schema:
          type: string
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/RawX12Request'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
components:
  schemas:
    ServiceLine:
      required:
      - professionalService
      - serviceDate
      type: object
      properties:
        assignedNumber:
          type: string
          description: 'Loop: 2400, Segment: LX, Element: LX01'
        serviceDate:
          type: string
          description: 'Loop: 2400, Segment: DTP, Element: DTP03, Notes: When sent with serviceDateEnd it will be used as the start date for Date Time period, if sent without serviceDateEnd will use DTP02 = D8. Expressed in Format CCYYMMDD'
          example: '20050514'
        serviceDateEnd:
          type: string
          description: 'Loop: 2400, Segment: DTP, Element: DTP03, Notes: Range of Dates Expressed in Format CCYYMMDD'
        providerControlNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF04-02 when REF01=6R'
        professionalService:
          $ref: '#/components/schemas/ProfessionalService'
        durableMedicalEquipmentService:
          $ref: '#/components/schemas/DurableMedicalEquipmentService'
        serviceLineSupplementalInformation:
          maxItems: 10
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/ReportInformation'
        durableMedicalEquipmentCertificateOfMedicalNecessity:
          $ref: '#/components/schemas/DurableMedicalEquipmentCertificateOfMedicalNecessity'
        ambulanceTransportInformation:
          $ref: '#/components/schemas/AmbulanceTransportInformation'
        durableMedicalEquipmentCertification:
          $ref: '#/components/schemas/DurableMedicalEquipmentCertification'
        ambulanceCertification:
          maxItems: 3
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/AmbulanceCertification'
        hospiceEmployeeIndicator:
          type: boolean
          description: 'Loop: 2400, Segment: CRC, Element: CRC02 Notes: True or False'
        conditionIndicatorDurableMedicalEquipment:
          $ref: '#/components/schemas/ConditionIndicatorDurableMedicalEquipment'
        serviceLineDateInformation:
          $ref: '#/components/schemas/ServiceLineDateInformation'
        ambulancePatientCount:
          type: integer
          description: 'Loop: 2400, Segment: QTY, Element: QTY02 when QTY01=PT'
          format: int32
        obstetricAnesthesiaAdditionalUnits:
          type: integer
          description: 'Loop: 2400, Segment: QTY, Element: QTY02 when QTY01=FL'
          format: int32
        testResults:
          maxItems: 5
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/Measurements'
        contractInformation:
          $ref: '#/components/schemas/ContractInformation'
        serviceLineReferenceInformation:
          $ref: '#/components/schemas/ServiceLineReferenceInformation'
        salesTaxAmount:
          type: string
          description: 'Loop: 2400, Segment: AMT, Element: AMT02 when AMT01=T'
        postageTaxAmount:
          type: string
          description: 'Loop: 2400, Segment: AMT, Element: AMT02 when AMT01=F4'
        fileInformation:
          maxItems: 10
          minItems: 0
          type: array
          description: 'Loop: 2400, Segment: K3, Element: K301'
          items:
            type: string
            description: 'Loop: 2400, Segment: K3, Element: K301'
        additionalNotes:
          type: string
          description: 'Loop: 2400, Segment: NTE, Element: NTE02 when NTE01=ADD'
        goalRehabOrDischargePlans:
          type: string
          description: 'Loop: 2400, Segment: NTE, Element: NTE02 when NTE01=DCP'
        thirdPartyOrganizationNotes:
          type: string
          description: 'Loop: 2400, Segment: NTE, Element: NTE02 when NTE01=TPO'
        purchasedServiceInformation:
          $ref: '#/components/schemas/PurchasedServiceInformation'
        linePricingRepricingInformation:
          $ref: '#/components/schemas/ClaimPricingRepricingInformation'
        drugIdentification:
          $ref: '#/components/schemas/DrugIdentification'
        renderingProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        purchasedServiceProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        serviceFacilityLocation:
          $ref: '#/components/schemas/ServiceFacilityLocation'
        supervisingProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        orderingProvider:
          $ref: '#/components/schemas/ServiceLineOrderingProvider'
        referringProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        ambulancePickUpLocation:
          $ref: '#/components/schemas/Address'
        ambulanceDropOffLocation:
          $ref: '#/components/schemas/Address'
        lineAdjudicationInformation:
          maxItems: 15
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/LineAdjudicationInformation'
        formIdentification:
          type: array
          items:
            $ref: '#/components/schemas/FormIdentification'
      description: Loop 2400
    ServiceFacilityLocation:
      required:
      - address
      - organizationName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2420C, Segment: NM1, Element: NM103'
          example: HAPPY DOCTORS GROUP
        address:
          $ref: '#/components/schemas/Address'
        npi:
          type: string
          description: 'Loop: 2420C, Segment: NM1, Element: NM109, Note: National Provider Identifier'
        secondaryIdentifier:
          maxItems: 3
          minItems: 0
          type: array
          description: 'Loop: 2420C: Segment: REF, Notes: A list containing qualifier (REF01), identifier (REF02), and otherIdentifier(REF04)'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
        phoneName:
          type: string
          description: 'Loop: 2310C, Segment: PER, Element: PER02'
        phoneNumber:
          type: string
          description: 'Loop: 2310C, Segment: PER, Element: PER04'
        phoneExtension:
          type: string
          description: 'Loop: 2310C, Segment: PER, Element: PER06'
    ProfessionalService:
      required:
      - compositeDiagnosisCodePointers
      - lineItemChargeAmount
      - measurementUnit
      - procedureCode
      - procedureIdentifier
      - serviceUnitCount
      type: object
      properties:
        procedureIdentifier:
          type: string
          description: 'Loop: 2400, Segment: SV1, Element: SV101-01, Notes: Allowed Values are: ''ER'' Jurisdiction Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, ''IV'' Home Infusion EDI Coalition (HIEC) Product/Service Code,''WK'' Advanced Billing Concepts (ABC) Codes'
          example: HC
          enum:
          - ER
          - HC
          - IV
          - WK
        procedureCode:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV101-02'
          example: E0570
        procedureModifiers:
          maxItems: 4
          minItems: 0
          type: array
          description: 'Loop 2400, Segment: SV1, Elements: SV101-03 to SV101-06, Notes: Required when modifier clarifies or improves the reporting accuracy of the associated procedure code. If not required then do not send'
          items:
            type: string
        description:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV101-07, Notes: A free form description to clarify teh related data elements and their content'
        lineItemChargeAmount:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV102, Notes: Required value for total charge amount, ''0'' (Zero) is acceptable for this value'
          example: '25'
        measurementUnit:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV103, Notes: Allowed values are ''MJ'' Minutes, ''UN'' Unit'
          example: UN
          enum:
          - MJ
          - UN
        serviceUnitCount:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV104, Notes: When a decimal is needed to report units, include it in this element'
          example: '1'
        placeOfServiceCode:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV105'
        compositeDiagnosisCodePointers:
          $ref: '#/components/schemas/CompositeDiagnosisCodePointers'
        emergencyIndicator:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV109'
          enum:
          - Y
        epsdtIndicator:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV111'
          enum:
          - Y
        familyPlanningIndicator:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV112'
          enum:
          - Y
        copayStatusCode:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV115'
          enum:
          - '0'
    ContractInformation:
      required:
      - contractTypeCode
      type: object
      properties:
        contractTypeCode:
          type: string
          description: 'Segment: CN1, Element: CN101, Allowed Values are: ''01'' Diagnosis Related Group (DRG), ''02'' Per Diem, ''03'' Variable Per Diem, ''04'' Flat, ''05'' Capitated, ''06'' Percent, ''09'' Other'
          example: '01'
          enum:
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - 09
        contractAmount:
          type: string
          description: 'Segment: CN1, Element: CN102'
        contractPercentage:
          type: string
          description: 'Segment: CN1, Element: CN103'
        contractCode:
          type: string
          description: 'Segment: CN1, Element: CN104'
        termsDiscountPercentage:
          type: string
          description: 'Segment: CN1, Element: CN105'
        contractVersionIdentifier:
          type: string
          description: 'Segment: CN1, Element: CN106'
      description: CN1
    ClaimDateInformation:
      type: object
      properties:
        symptomDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        initialTreatmentDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastSeenDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        acuteManifestationDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        accidentDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastMenstrualPeriodDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastXRayDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        hearingAndVisionPrescriptionDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        disabilityBeginDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        disabilityEndDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastWorkedDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        authorizedReturnToWorkDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        admissionDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        dischargeDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        assumedAndRelinquishedCareBeginDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        assumedAndRelinquishedCareEndDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        repricerReceivedDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        firstContactDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
      description: DTP
    LineAdjudicationInformation:
      required:
      - adjudicationOrPaymentDate
      - otherPayerPrimaryIdentifier
      - paidServiceUnitCount
      - procedureCode
      - serviceIdQualifier
      - serviceLinePaidAmount
      type: object
      properties:
        otherPayerPrimaryIdentifier:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD01'
        serviceLinePaidAmount:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD02'
        serviceIdQualifier:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD03-01, Note: Allowed Values are: ''ER'' Jurisdiction Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, ''HP'' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, ''IV'' Home Infusion EDI Coalition (HIEC) Product/Service Code, ''WK'' Advanced Billing Concepts (ABC) Codes'
          enum:
          - ER
          - HC
          - HP
          - IV
          - WK
        procedureCode:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD03-02'
        procedureModifier:
          maxItems: 4
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop: 2430, Segment: SVD, Element: SVD03-03, SVD03-04, SVD03-05, SVD03-06'
        procedureCodeDescription:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD03-07'
        paidServiceUnitCount:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD05'
        bundledOrUnbundledLineNumber:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD06'
        claimAdjustmentInformation:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2430, Segment: CAS'
          items:
            $ref: '#/components/schemas/ClaimAdjustment'
        adjudicationOrPaymentDate:
          type: string
          description: 'Loop: 2430, Segment: DTP, Element=DTP03 when DTP02=D8 and DTP01=573'
        remainingPatientLiability:
          type: string
          description: 'Loop: 2430, Segment: AMT, Element=AMT02 when AMT01=EAF'
      description: SVD, CAS, DTP and AMT
    ClaimPricingRepricingInformation:
      required:
      - pricingMethodologyCode
      - repricedAllowedAmount
      type: object
      properties:
        pricingMethodologyCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP01, Note: Allowed Values are: ''00'' Zero Pricing (Not Covered Under Contract), ''01'' Priced as Billed at 100%, ''02'' Priced at the Standard Fee Schedule, ''03'' Priced at a Contractual Percentage, ''04'' Bundled Pricing, ''05'' Peer Review Pricing, ''06'' Bundled Pricing, ''07'' Flat Rate Pricing, ''08'' Combination Pricing, ''09'' Maternity Pricing, ''10'' Other Pricing, ''11'' Lower of Cost, ''12'' Ratio of Cost, ''13'' Cost Reimbursed, ''14'' Adjustment Pricing'
          example: '01'
          enum:
          - '00'
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - '07'
          - 08
          - 09
          - '10'
          - '11'
          - '12'
          - '13'
          - '14'
        repricedAllowedAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP02'
          example: '1'
        repricedSavingAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP03'
        repricingOrganizationIdentifier:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP04'
        repricingPerDiemOrFlatRateAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP05'
        repricedApprovedAmbulatoryPatientGroupCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP06'
        repricedApprovedAmbulatoryPatientGroupAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP07'
        rejectReasonCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP13, Note: Allowed Values are: ''T1'' Cannot Identify Provider as TPO (Third Party Organization) Participant, ''T2'' Cannot Identify Payer as TPO (Third Party Organization) Participant, ''T3'' Cannot Identify Insured as TPO (Third Party Organization) Participant, ''T4'' Payer Name or Identifier Missing, ''T5'' Certification Information Missing, ''16'' Claim does not contain enough information for repricing'
          enum:
          - T1
          - T2
          - T3
          - T4
          - T5
          - T6
        policyComplianceCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP14, Note: Allowed Values are: ''1'' Procedure Followed (Compliance), ''2'' Not Followed - Call Not Made (Non-Compliance Call Not Made), ''3'' Not Medically Necessary (Non-Compliance Non-Medically Necessary), ''4'' Not Followed Other (Non-Compliance Other), ''5'' Emergency Admit to Non-Network Hospital'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
        exceptionCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP15, Note: Allowed Values are: ''1'' Non-Network Professional Provider in Network Hospital, ''2'' Emergency Care, ''3'' Services or Specialist not in Network, ''4'' Out-of-Service Area, ''5'' State Mandates, ''6'' Other'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
          - '6'
      description: HCP
    ClaimInformation:
      required:
      - benefitsAssignmentCertificationIndicator
      - claimChargeAmount
      - claimFilingCode
      - claimFrequencyCode
      - healthCareCodeInformation
      - patientControlNumber
      - placeOfServiceCode
      - planParticipationCode
      - releaseInformationCode
      - serviceLines
      - signatureIndicator
      type: object
      properties:
        claimFilingCode:
          type: string
          description: 'Loop 2000B, Segment: SBR, Element: SBR09, Note: Allowed Values are: ''11'' Other Non-Federal Programs, ''12'' Preferred Provider Organization (PPO), ''13'' Point of Service (POS), ''14'' Exclusive Provider Organization (EPO), ''15'' Indemnity Insurance, ''16'' Health Maintenance Organization (HMO) Medicare Risk, ''17'' Dental Maintenance Organization, ''AM'' Automobile Medical, ''BL'' Blue Cross/Blue Shield, ''CH'' Champus, ''CI'' Commercial Insurance Co., ''DS'' Disability, ''FI'' Federal Employees Program, ''HM'' Health Maintenance Organization, ''LM'' Liability Medical, ''MA'' Medicare Part A,  ''MB'' Medicare Part B,  ''MC'' Medicaid, ''OF'' Other Federal Program, ''TV'' Title V, ''VA'' Veterans Affairs Plan, ''WC'' Workers'' Compensation Health Claim, ''ZZ'' Mutually Defined'
          example: CI
          enum:
          - '11'
          - '12'
          - '13'
          - '14'
          - '15'
          - '16'
          - '17'
          - AM
          - BL
          - CH
          - CI
          - DS
          - FI
          - HM
          - LM
          - MA
          - MB
          - MC
          - OF
          - TV
          - VA
          - WC
          - ZZ
        propertyCasualtyClaimNumber:
          type: string
          description: 'Loop 2010BA, Segment: REF, Element: REF02'
        deathDate:
          type: string
          description: 'Loop 2000B and 2000C, Segment: PAT, Element: PAT06 and PAT05=D8'
        patientWeight:
          type: string
          description: 'Loop 2000B and 2000C, Segment: PAT, Element: PAT08 and PAT07=01'
        pregnancyIndicator:
          type: string
          description: 'Loop 2000B and 2000C, Segment: PAT, Element: PAT09'
          enum:
          - Y
        patientControlNumber:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM01'
          example: '12345'
        claimChargeAmount:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM02'
          example: '28.75'
        placeOfServiceCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM05-01'
          example: '11'
        claimFrequencyCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM05-03'
          example: '1'
        signatureIndicator:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM06, Note: Allowed Values are: ''N'' NO, ''Y'' Yes'
          example: Y
          enum:
          - N
          - Y
        planParticipationCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM07, Note: Allowed Values are: ''A'' Assigned, ''B'' Assignment Accepted on Clinical Lab Services Only, ''C'' Not Assigned'
          example: A
          enum:
          - A
          - B
          - C
        benefitsAssignmentCertificationIndicator:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM08, Note: Allowed Values are: ''N'' No, ''W'' Not Applicable - Use code ''W'' when the patient refuses to assign benefits, ''Y'' Yes'
          example: Y
          enum:
          - N
          - W
          - Y
        releaseInformationCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM09, Note: Allowed Values are: ''I'' Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes, ''Y'' Yes'
          example: Y
          enum:
          - I
          - Y
        patientSignatureSourceCode:
          type: boolean
          description: 'Loop 2300, Segment: CLM, Element: CLM10, Note: Allowed Values are: ''P'' Signature generated by provider because the patient was not physically present for services'
          enum:
          - false
        relatedCausesCode:
          maxItems: 2
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: CLM, Element: CLM11-01, CLM11-02, Note: Allowed Values are: ''AA'' Auto Accident, ''EM'' Employment, ''OA'' Other Accident'
          items:
            type: string
            enum:
            - AA
            - EM
            - OA
        autoAccidentStateCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM11-04, Note: When CLM11-1 or CLM11-2 has a value of ''AA'' to identify the state, province or sub-country code in which the automobile accident occurred.'
          enum:
          - AA
          - EM
          - OA
        autoAccidentCountryCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM11-05, Note: When CLM11-1 or CLM11-2 = AA and the accident occurred in a country other than US or Canada.'
        specialProgramCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM12, Note: Allowed Values are: ''02'' Physically Handicapped Children''s Program, ''03'' Special Federal Funding, ''05'' Disabolity, ''09'' Second Opinion or Surgery'
          enum:
          - '02'
          - '03'
          - '05'
          - 09
        delayReasonCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM20, Note: Allowed Values are: ''1'' Proof of Eligibility Unknown or Unavailable, ''2'' Litigation, ''3'' Authorization Delays, ''4'' Delay in Certifying Provider, ''5'' Delay in Supplying Billing Forms, ''6'' Delay in Delivery of Custom-made Appliances, ''7'' Third Party Processing Delay, ''8'' Delay in Eligibility Determination,  ''9'' Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules, ''10'' Administration Delay in the Prior Approval Process, ''11'' Other, ''15'' Natural Disaster'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
          - '6'
          - '7'
          - '8'
          - '9'
          - '10'
          - '11'
          - '15'
        patientAmountPaid:
          type: string
          description: 'Loop 2300, Segment: AMT, Element: AMT02'
        fileInformation:
          type: string
          description: 'Loop 2300, Segment: K3, Element: K301'
        fileInformationList:
          maxItems: 10
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: K3, Element: K301'
          items:
            type: string
            description: 'Loop 2300, Segment: K3, Element: K301'
        claimDateInformation:
          $ref: '#/components/schemas/ClaimDateInformation'
        claimContractInformation:
          $ref: '#/components/schemas/ClaimContractInformation'
        claimSupplementalInformation:
          $ref: '#/components/schemas/ClaimSupplementalInformation'
        claimNote:
          $ref: '#/components/schemas/ClaimNote'
        ambulanceTransportInformation:
          $ref: '#/components/schemas/AmbulanceTransportInformation'
        spinalManipulationServiceInformation:
          $ref: '#/components/schemas/SpinalManipulationServiceInformation'
        ambulanceCertification:
          maxItems: 3
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: CRC'
          items:
            $ref: '#/components/schemas/AmbulanceCertification'
        patientConditionInformationVision:
          maxItems: 3
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: CRC'
          items:
            $ref: '#/components/schemas/PatientConditionInformationVision'
        homeboundIndicator:
          type: boolean
          description: 'Loop 2300, Segment: CRC'
        epsdtReferral:
          $ref: '#/components/schemas/EpsdtReferral'
        healthCareCodeInformation:
          maxItems: 12
          minItems: 1
          type: array
          description: 'Loop 2300, Segment: HI'
          items:
            $ref: '#/components/schemas/HealthCareInformation'
        anesthesiaRelatedSurgicalProcedure:
          maxItems: 2
          minItems: 1
          type: array
          description: 'Loop 2300, Segment: HI'
          items:
            type: string
            description: 'Loop 2300, Segment: HI'
        conditionInformation:
          maxItems: 2
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: HI'
          items:
            $ref: '#/components/schemas/ConditionInformation'
        claimPricingRepricingInformation:
          $ref: '#/components/schemas/ClaimPricingRepricingInformation'
        serviceFacilityLocation:
          $ref: '#/components/schemas/ServiceFacilityLocation'
        ambulancePickUpLocation:
          $ref: '#/components/schemas/Address'
        ambulanceDropOffLocation:
          $ref: '#/components/schemas/Address'
        otherSubscriberInformation:
          maxItems: 10
          minItems: 0
          type: array
          description: Loop 2320
          items:
            $ref: '#/components/schemas/OtherSubscriberInformation'
  

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# Full source: https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-professional-claims-api-openapi.yml