Optum

Optum Submission API

The Submission API from Optum — 2 operation(s) for submission.

GitHub OpenAPI
Business capability
Eligibility & Benefits Verification BC-2800.30

Operations 2

POST /submission/x12 278x217 Prior Authorization Submission
POST /submission JSON Prior Authorization Submission

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-submission-api-openapi.yml

Other Resources

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

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OpenAPI Specification

optum-submission-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Prior Authorization v1 Submission 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: Submission
paths:
  /submission/x12:
    post:
      summary: 278x217 Prior Authorization Submission
      description: Prior authorization submission using EDI X12 278x217 requests
      tags:
      - Submission
      parameters:
      - $ref: '#/components/parameters/x-optum-tenant-id'
      - $ref: '#/components/parameters/x-optum-correlation-id'
      requestBody:
        description: Authorization Submission request
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/SubmissionX12Request'
      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/SubmissionResponse'
              examples:
                subscriber:
                  $ref: '#/components/examples/UserSubmissionResponseSubscriber'
                dependent:
                  $ref: '#/components/examples/UserSubmissionResponseDependent'
        '400':
          $ref: '#/components/responses/400'
        '401':
          $ref: '#/components/responses/401'
        '403':
          $ref: '#/components/responses/403'
        '500':
          $ref: '#/components/responses/500'
  /submission:
    post:
      summary: JSON Prior Authorization Submission
      description: Prior authorization submission using JSON requests
      tags:
      - Submission
      parameters:
      - $ref: '#/components/parameters/x-optum-tenant-id'
      - $ref: '#/components/parameters/x-optum-correlation-id'
      requestBody:
        description: Authorization submission request
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/AuthorizationSubmissionJSON'
            examples:
              subscriber:
                $ref: '#/components/examples/UserSubmissionRequestSubscriber'
              dependent:
                $ref: '#/components/examples/UserSubmissionRequestDependent'
      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/SubmissionResponse'
              examples:
                subscriber:
                  $ref: '#/components/examples/UserSubmissionResponseSubscriber'
                dependent:
                  $ref: '#/components/examples/UserSubmissionResponseDependent'
        '400':
          $ref: '#/components/responses/400'
        '401':
          $ref: '#/components/responses/401'
        '403':
          $ref: '#/components/responses/403'
        '500':
          $ref: '#/components/responses/500'
components:
  schemas:
    AuthorizationSubmissionJSON:
      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
                      unitOrBasisForMeasurementCode:
                        type: string
                      serviceUnitCount:
                        type: string
                      diagnosisCodePointer1:
                        type: string
                      diagnosisCodePointer2:
                        type: string
                      diagnosisCodePointer3:
                        type: string
                      diagnosisCodePointer4:
                        type: string
                      epsdtIndicator:
                        type: string
                      nursingHomeLevelOfCare:
                        type: string
                  institutionalService:
                    type: object
                    properties:
                      serviceLineRevenueCode:
                        type: string
                      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
                      unitOrBasisForMeasurementCode:
                        type: string
                      serviceUnitCount:
                        type: string
                      serviceLineRate:
                        type: string
                      nursingHomeResidentialStatusCode:
                        type: string
                      nursingHomeLevelOfCare:
                        type: string
                  dentalService:
                    type: object
                    properties:
                      procedureCode:
                        type: string
                      procedureModifier1:
                        type: string
                      procedureModifier2:
                        type: string
                      procedureModifier3:
                        type: string
                      procedureModifier4:
                        type: string
                      procedureCodeDescription:
                        type: string
                      procedureCode2:
                        type: string
                      serviceLineAmount:
                        type: string
                      oralCavityDesignationCode:
                        type: string
                      oralCavityDesignationCode2:
                        type: string
                      oralCavityDesignationCode3:
                        type: string
                      oralCavityDesignationCode4:
                        type: string
                      oralCavityDesignationCode5:
                        type: string
                      prosthesisCrownOrInlayCode:
                        type: string
                      serviceUnitCount:
                        type: string
                      description:
                        type: string
                  toothInformation:
                    type: array
                    items:
                      type: object
                      properties:
                        toothCode:
                          type: string
                        toothSurfaceCode1:
                          type: string
                        toothSurfaceCode2:
                          type: string
                        toothSurfaceCode3:
                          type: string
                        toothSurfaceCode4:
                          type: string
                        toothSurfaceCode5:
                          type: string
                  healthCareServiceDelivery:
                    type: object
                    properties:
                      quantityQualifier:
                        type: string
                      serviceQuantity:
                        type: string
                      unitOrBasisForMeasurementCode:
                        type: string
                      sampleSelectionModulus:
                        type: string
                      timePeriodQualifier:
                        type: string
                      periodCount:
                        type: string
                      deliveryFrequencyCode:
                        type: string
                      deliveryPatternTimeCode:
                        type: string
                  attachments:
                    type: array
                    items:
                      type: object
                      properties:
                        reportTypeCode:
                          type: string
                        transmissionCode:
                          type: string
                        controlNumber:
                          type: string
                        description:
                          type: string
                  freeFormMessageText:
                    type: string
                  serviceProviderName:
                    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

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