Optum

Optum, part of UnitedHealth Group, is a health services and technology company that operates one of the largest medical, dental and pharmacy networks in the United States and runs the clearinghouse formerly known as Change Healthcare. Its developer platform (developer.optum.com) publishes eight product lines of RESTful JSON, native X12 EDI and HL7 FHIR R4 APIs: eligibility and coverage discovery, professional and institutional claim validation and submission, claim status, ERA/remittance reports, attachments, payer directory and outage feeds, prior authorization in both X12 278 and FHIR Da Vinci PAS/DTR/CRD form, provider access and bulk member match, dental pre-care estimates and claims, pharmacy formatting and submitter services, payer enrollment and document tracking, and Optum Insight Platform data, code-search and analytics services. Every API is secured with an OAuth2 client-credentials JWT bearer token over TLS 1.2+, with a free canned-response sandbox on a separate host. Optum also publishes an RFC 9727 API catalog at /.well-known/api-catalog, which is how the 59 OpenAPI documents in this repo were harvested.

Optum publishes 8 APIs on the APIs.io network, including Medical Network Eligibility and Claims API, Real (Medical) API, Real for Dental API, and 5 more. Tagged areas include Company, Healthcare, Health Insurance, Claims, and Eligibility.

The Optum catalog on APIs.io includes 1 event-driven AsyncAPI specification.

Optum’s developer surface includes authentication, documentation, API reference, getting-started guide, support, signup flow, sandbox, and 32 more developer resources.

🌐 Visit website 📡 Source on GitHub

57.8/100 strong ▲ 26.0 Agent 64/100 agent ready Full breakdown ↓
scored 2026-08-17 · rubric v0.11.0

AccessSelf serve

9 APIs

CompanyHealthcareHealth InsuranceClaimsEligibilityFHIRInteroperabilityPharmacyEDIX12PaymentsPrior AuthorizationClearinghouseRevenue CycleDentalDa VinciPatient AccessRemittanceAttachmentsPayer Directory

Kin Score

Kin Score How this is scored →
scored 2026-08-17 · rubric v0.11.0

Composite quality — 57.8/100 · strong

Contract Quality 12.6 / 21

Developer Ergonomics 11.1 / 17

Commercial Clarity 8.9 / 17

Operational Transparency 6.1 / 11

Governance 1.2 / 10

Discoverability 7.9 / 9

Regulatory Posture 9.9 / 15

Agent readiness — 64/100 · agent ready

Machine-Readable Contract 18 / 18

Agentic Access Contract 10 / 10

MCP Server 0 / 12

Machine-Readable Auth 10 / 10

Idempotency 0 / 9

Stable Error Semantics 8 / 8

Request/Response Examples 7 / 7

Rate-Limit Signaling 7 / 7

Typed Event Surface 6 / 6

Agent Skills 5 / 5

Well-Known Catalog 4 / 4

Consent & Bot Identity 3 / 3

A2A Agent Card 0 / 8

Dry-Run / Simulate Mode 0 / 4

Regulatory Posture applies to this provider. Its tags matched the Health regime, so Regulatory Posture carries 15 points of the composite. If this regime is wrong for your business, say so on your provider repo — the applicability map is public and we will correct it.

The six quality facets above are damped to 85 points between them, because the conditional facet above carries the other 15. That is why each facet's contribution is shown against a damped maximum: raising a quality facet moves the composite by 85% of its nominal weight, not 100%. The full arithmetic is at apis.io/rating/.

Improve this rating by publishing the missing artifacts — every area above can be raised, and the full rubric is at apis.io/rating/. This rating is computed from github.com/api-evangelist/optum: open an issue to ask a question, or submit a pull request to add artifacts. Want it done for you? Prioritized profiling — $2,500 →

APIs 9

Individual APIs this provider publishes, each with its own machine-readable definition.

Rate Limits 1

Documented rate limits and quota policies.

Scopes 1

OAuth scopes governing access to this provider's APIs.

Optum Scopes

7 scopes · clientCredentials/authorizationCode

7 scopes

SCOPES

Agentic Access 1

Recommended x-agentic-access execution contracts for AI agents.

Optum Agentic Access

483 operations · 122 acting · 3 human-in-the-loop

483 operations · 122 acting

AGENTIC

Resources

Get Started 5

Portal, sign-up, and the first successful call

DeveloperPortal

GettingStarted

SignUp

Sandbox

Sandbox

Documentation 2

Reference material describing how the API behaves

Documentation

Documentation

APIReference

APIReference

Agent Surfaces 4

MCP servers, agent skills, and machine-readable catalogs

AgenticAccess

WellKnown

LLMsTxt

AgentSkill

Design & Contract 6

Pagination, idempotency, versioning, errors, and events

Conventions

Conformance

Lifecycle

ErrorCatalog

DataModel

Webhooks

Build 3

SDKs, sample code, and the tooling you integrate with

Packages

Packages

Examples

Examples

GitHubOrganization

GitHubOrganization

Access & Security 7

Authentication, authorization, and security posture

OAuthScopes

OAuthScopes

VulnerabilityDisclosure

VulnerabilityDisclosure

Security

DomainSecurity

Authentication

SecurityTxt

Compliance

Scroll for all 7

Operate 4

Status, limits, changes, and where to get help

Support

StatusPage

ChangeLog

RateLimits

Commercial 4

Pricing, plans, and the legal terms of use

TermsOfService

PrivacyPolicy

Plans

Pricing

Company 2

The organization behind the API

Website

Website

Blog

Blog

Other 2

Properties that don't map to a standard resource type

Overlay

Overlay

APICatalog

APICatalog

Source (apis.yml)

aid: optum
name: Optum
description: 'Optum, part of UnitedHealth Group, is a health services and technology company that operates one of the largest
  medical, dental and pharmacy networks in the United States and runs the clearinghouse formerly known as Change Healthcare.
  Its developer platform (developer.optum.com) publishes eight product lines of RESTful JSON, native X12 EDI and HL7 FHIR
  R4 APIs: eligibility and coverage discovery, professional and institutional claim validation and submission, claim status,
  ERA/remittance reports, attachments, payer directory and outage feeds, prior authorization in both X12 278 and FHIR Da Vinci
  PAS/DTR/CRD form, provider access and bulk member match, dental pre-care estimates and claims, pharmacy formatting and submitter
  services, payer enrollment and document tracking, and Optum Insight Platform data, code-search and analytics services. Every
  API is secured with an OAuth2 client-credentials JWT bearer token over TLS 1.2+, with a free canned-response sandbox on
  a separate host. Optum also publishes an RFC 9727 API catalog at /.well-known/api-catalog, which is how the 59 OpenAPI documents
  in this repo were harvested.'
url: https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/apis.yml
x-type: company
x-source: vc-portfolio
x-backed-by:
- insight-partners
x-tier: profiled
x-tier-reason: full-contract-harvest
accessModel:
  pricing: unknown
  onboarding: self-serve
  trial: false
  try_now: false
  public: false
  label: Self-serve signup
  confidence: medium
  source:
  - authentication
  generated: '2026-07-22'
  method: derived
image: https://www.optum.com/content/dam/optum4/images/logos/optum-logo.svg
specificationVersion: '0.20'
created: '2026-07-17'
modified: '2026-08-14'
tags:
- Company
- Healthcare
- Health Insurance
- Claims
- Eligibility
- FHIR
- Interoperability
- Pharmacy
- EDI
- X12
- Payments
- Prior Authorization
- Clearinghouse
- Revenue Cycle
- Dental
- Da Vinci
- Patient Access
- Remittance
- Attachments
- Payer Directory
apis:
- name: Optum Medical Network Eligibility and Claims API
  description: RESTful JSON and native X12 EDI (270/271, 837P/837I, 276/277, 835) healthcare transaction APIs for real-time
    patient eligibility and coverage verification, enhanced eligibility with asynchronous coverage discovery, professional
    and institutional claim validation and submission, claim status inquiry, ERA and 277CA claim-response reports, prior authorization
    (X12 278), attachment submission/status/retrieval, and the payer directory with live payer outage data.
  humanURL: https://developer.optum.com/eligibilityandclaims
  baseURL: https://apigw.optum.com/medicalnetwork/
  tags:
  - Eligibility
  - Claims
  - Claim Status
  - ERA
  - Prior Authorization
  - X12
  - Attachments
  - Payer Directory
  properties:
  - type: APIReference
    url: https://developer.optum.com/eligibilityandclaims/reference/api-overview
  - type: GettingStarted
    url: https://developer.optum.com/eligibilityandclaims/docs/get-started-with-optum-api
  - type: Authentication
    url: https://developer.optum.com/eligibilityandclaims/docs/optum-security-and-authorization
  - type: ChangeLog
    url: https://developer.optum.com/eligibilityandclaims/docs/eligibility-release-notes
  - type: OpenAPI
    url: openapi/optum-dental-attachment-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-enhanced-eligibility-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-attachment-retrieval-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-attachment-status-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-attachments-submission-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-claim-status-v2-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-claims-responses-and-reports-v2-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-eligibility-v3-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-institutional-claims-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-medical-network-professional-claims-v3-openapi.yml
  - type: OpenAPI
    url: openapi/optum-payer-list-api-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-prior-authorization-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-security-and-authorization-v3-openapi.yml
- name: Optum Real (Medical) API
  description: 'Optum Real point-of-care APIs on the oihub gateway: pre-service eligibility, claim pre-check, claim actions,
    claim inquiry, patient benefit check, document search, auth referral submission, plus HL7 FHIR R4 Da Vinci implementations
    — Prior Authorization Support (PAS $submit/$inquire/$submit-attachment), Documentation Templates and Rules (DTR questionnaire
    package and adaptive $next-question), Coverage Requirements Discovery over CDS Hooks, and Provider Access with $bulk-member-match
    and $davinci-data-export.'
  humanURL: https://developer.optum.com/optumreal-medical
  baseURL: https://apigw.optum.com/oihub/
  tags:
  - FHIR
  - Da Vinci
  - Prior Authorization
  - CDS Hooks
  - Provider Access
  - Eligibility
  - Claims
  - Benefit Check
  properties:
  - type: APIReference
    url: https://developer.optum.com/optumreal-medical/reference/overview-optum-real-api
  - type: ChangeLog
    url: https://developer.optum.com/optumreal-medical/reference/real-api-release-notes
  - type: OpenAPI
    url: openapi/optum-attachment-openapi.yml
  - type: OpenAPI
    url: openapi/optum-auth-referral-submission-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-auth-referral-submission-health-check-openapi.yml
  - type: OpenAPI
    url: openapi/optum-authorization-auth-only-openapi.yml
  - type: OpenAPI
    url: openapi/optum-benefit-check-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-claim-actions-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-claim-actions-health-check-openapi.yml
  - type: OpenAPI
    url: openapi/optum-claim-inquiry-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-claim-inquiry-health-check-openapi.yml
  - type: OpenAPI
    url: openapi/optum-claim-pre-check-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-document-search-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-document-search-health-check-openapi.yml
  - type: OpenAPI
    url: openapi/optum-eligibility-pre-service-health-check-openapi.yml
  - type: OpenAPI
    url: openapi/optum-optum-real-health-check-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-optum-real-pre-service-eligibility-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-patient-benefit-check-health-check-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-prior-authorization-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-provider-access-api-openapi.yml
- name: Optum Real for Dental API
  description: Real-time dental data exchange APIs for pre-care eligibility and eligibility intelligence, pre-care cost estimates,
    claim submission (GraphQL-backed), claim status inquiry, and attachments with image intelligence over dental radiographs.
    The legacy Change Healthcare dental attachment surface (/dentalnetwork/attachments/v1) is the only Optum API that documents
    a 429 rate-limit response.
  humanURL: https://developer.optum.com/optumreal-dental
  baseURL: https://apigw.optum.com/oihub/dental/
  tags:
  - Dental
  - Eligibility
  - Claims
  - Attachments
  - Pre-Care Estimate
  - GraphQL
  properties:
  - type: APIReference
    url: https://developer.optum.com/optumreal-dental/reference/overview-real-dental
  - type: GettingStarted
    url: https://developer.optum.com/optumreal-dental/reference/get-started
  - type: OpenAPI
    url: openapi/optum-dental-pre-care-estimate-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-dental-attachments-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-dental-claim-submission-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-dental-pre-care-eligibility-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-dental-claim-status-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-real-dental-pre-care-eligibility-intelligence-api-openapi.yml
- name: Optum Pharmacy Solutions API
  description: 'Pharmacy network services: a formatting rule API and telecom formatter for NCPDP-style pharmacy claim formatting,
    and a submitter API for managing pharmacy network submitters.'
  humanURL: https://developer.optum.com/pharmacysolutions
  baseURL: https://apigw.optum.com/pharmacynetwork/
  tags:
  - Pharmacy
  - NCPDP
  - Formatting
  - Submitter
  properties:
  - type: APIReference
    url: https://developer.optum.com/pharmacysolutions/reference
  - type: OpenAPI
    url: openapi/optum-formatting-rule-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-submitter-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-telecom-formatter-api-openapi.yml
- name: Optum Payment and Reimbursement API
  description: 'Payer enrollment and document tracking for the Optum intelligent clearinghouse: PES payer enrollments, EDI
    enrollment, and a file and document tracking API for following submissions through the clearinghouse.'
  humanURL: https://developer.optum.com/paymentandreimbursement
  baseURL: https://apigw.optum.com/intelligentclearinghouse/
  tags:
  - Payments
  - Enrollment
  - EDI
  - Document Tracking
  - Clearinghouse
  properties:
  - type: APIReference
    url: https://developer.optum.com/paymentandreimbursement/reference
  - type: OpenAPI
    url: openapi/optum-edi-enrollment-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-file-and-document-tracking-api-v1-openapi.yml
  - type: OpenAPI
    url: openapi/optum-pes-payer-enrollments-v1-openapi.yml
- name: Optum Insight Platform (Platform and Interoperability) API
  description: 'Optum Insight Platform services published on gateway.optuminsightplatform.com: NCC data acquisition, a code-search
    core service, CMS and Optum common physician and facility provider-directory services, cross-community REST document exchange,
    an ODX XDR ingestion service, and real-time eContent web services. These are the largest specs on the platform — the CMS
    Common Facility service alone declares 69 operations.'
  humanURL: https://developer.optum.com/platformandinteroperability
  baseURL: https://gateway.optuminsightplatform.com/
  tags:
  - Interoperability
  - Provider Directory
  - Data Exchange
  - Code Search
  - Document Exchange
  - CMS
  properties:
  - type: APIReference
    url: https://developer.optum.com/platformandinteroperability/reference
  - type: OpenAPI
    url: openapi/optum-cms-common-facility-openapi.yml
  - type: OpenAPI
    url: openapi/optum-cms-common-physician-openapi.yml
  - type: OpenAPI
    url: openapi/optum-core-service-openapi.yml
  - type: OpenAPI
    url: openapi/optum-cross-community-rest-apis-xc-rest-openapi.yml
  - type: OpenAPI
    url: openapi/optum-ncc-data-acquisition-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-odx-v3-xdr-ingestion-service-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-optum-common-facility-openapi.yml
  - type: OpenAPI
    url: openapi/optum-optum-common-physician-openapi.yml
  - type: OpenAPI
    url: openapi/optum-optum-real-time-econtent-web-services-openapi.yml
- name: Optum Analytics and Insights API
  description: 'Analytics and payment-integrity APIs: PROMETHEUS Analytics job submission and check-job for episode-of-care
    analytics, ABM care decision support, and ABM pre-pay DME, pre-pay lab and prior-authorization review APIs.'
  humanURL: https://developer.optum.com/analyticsandinsights
  baseURL: https://apigw.optum.com/
  tags:
  - Analytics
  - Payment Integrity
  - Decision Support
  - Prior Authorization
  - Episodes of Care
  properties:
  - type: APIReference
    url: https://developer.optum.com/analyticsandinsights/reference
  - type: OpenAPI
    url: openapi/optum-abm-care-decision-support-api-openapi.yml
  - type: OpenAPI
    url: openapi/optum-abm-pre-pay-lab-api-1-0-0-openapi.yml
  - type: OpenAPI
    url: openapi/optum-abm-prepay-dme-claim-api-1-0-0-openapi.yml
  - type: OpenAPI
    url: openapi/optum-abm-priorauth-api-1-0-0-openapi.yml
  - type: OpenAPI
    url: openapi/optum-prometheus-analytics-api-job-submission-openapi.yml
  - type: OpenAPI
    url: openapi/optum-prometheus-analytics-checkjob-openapi.yml
- name: Optum API Tools — Security and Authorization
  description: The platform OAuth2 token service. Security and Authorization v2 issues a one-hour JWT bearer token at /apip/auth/v2/token
    for the Medical Network and Dental APIs; v3 ("sentinel") issues one at /apip/auth/sntl/v1/token for the Optum Real oihub
    APIs. Both generations are live simultaneously.
  humanURL: https://developer.optum.com/apitools
  baseURL: https://apigw.optum.com/apip/auth/
  tags:
  - Authentication
  - OAuth2
  - Tokens
  properties:
  - type: APIReference
    url: https://developer.optum.com/apitools/reference/security-and-authorization-v2-overview
  - type: Documentation
    url: https://developer.optum.com/apitools/docs/getting-started
  - type: OpenAPI
    url: openapi/optum-security-and-authorization-v2-openapi.yml
- name: Optum Interoperability APIs (CMS Patient Access)
  description: Optum's payer-side CMS Interoperability and Patient Access (CMS-9115-F) surface — Patient Access, Provider
    Directory and Payer-to-Payer exchange for the Optum behavioral and physical health plans. The former developer.optum.com/dataaccessandinteroperability
    ReadMe project no longer resolves (every path returned the portal shell when probed on 2026-08-14); the developer information
    is now published as per-plan PDF packets on optum.com, so there is no machine-readable contract for this surface.
  humanURL: https://www.optum.com/en/interoperability-apis.html
  baseURL: https://apigw.optum.com/
  tags:
  - FHIR
  - Patient Access
  - Interoperability
  - CMS
  - Provider Directory
  properties:
  - type: Documentation
    url: https://www.optum.com/en/interoperability-apis.html
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com
- FN: APIs.json
  email: info@apis.io
common:
- type: AgenticAccess
  url: agentic-access/optum-agentic-access.yml
- type: OAuthScopes
  url: scopes/optum-scopes.yml
- type: VulnerabilityDisclosure
  url: security/optum-vulnerability-disclosure.yml
- type: Security
  url: https://www.optum.com/vulnerability.html
- type: DomainSecurity
  url: security/optum-domain-security.yml
- type: Authentication
  url: authentication/optum-authentication.yml
- type: Conventions
  url: conventions/optum-conventions.yml
- type: Conformance
  url: conformance/optum-conformance.yml
- type: Lifecycle
  url: lifecycle/optum-lifecycle.yml
- type: WellKnown
  url: well-known/optum-well-known.yml
- type: SecurityTxt
  url: well-known/optum-security.txt
- type: LLMsTxt
  url: llms/optum-llms.txt
- type: DeveloperPortal
  url: https://developer.optum.com/
- type: Documentation
  url: https://developer.optum.com/apitools/docs/getting-started
- type: APIReference
  url: https://developer.optum.com/eligibilityandclaims/reference/api-overview
- type: GettingStarted
  url: https://developer.optum.com/eligibilityandclaims/docs/get-started-with-optum-api
- type: Support
  url: https://community.optum.com/developers/home
- type: SignUp
  url: https://marketplace.optum.com/apiservices/api-sandbox-access
- type: Sandbox
  url: https://marketplace.optum.com/apiservices/api-sandbox-access
- type: Website
  url: https://www.optum.com/
- type: TermsOfService
  url: https://www.optum.com/terms-of-use.html
- type: PrivacyPolicy
  url: https://www.optum.com/privacy-policy.html
- type: Packages
  url: packages/optum-packages.yml
- type: Compliance
  url: https://business.optum.com/en/federal-government/about-optum-serve/certifications-partnerships.html
- type: ErrorCatalog
  url: errors/optum-problem-types.yml
- type: DataModel
  url: data-model/optum-data-model.yml
- type: Examples
  url: examples/optum-examples.yml
- type: StatusPage
  url: https://status.optum.com/
- type: ChangeLog
  url: changelog/optum-changelog.yml
- type: Sandbox
  url: sandbox/optum-sandbox.yml
- type: RateLimits
  url: rate-limits/optum-rate-limits.yml
- type: Plans
  url: plans/optum-plans-pricing.yml
- type: Pricing
  url: https://marketplace.optum.com/apiservices/api-sandbox-access
- type: Webhooks
  url: asyncapi/optum-webhooks.yml
- type: AgentSkill
  url: skills/_index.yml
- type: Overlay
  url: overlays/optum-servers-and-provenance-overlay.yaml
- type: APICatalog
  url: https://developer.optum.com/.well-known/api-catalog
- type: GitHubOrganization
  url: https://github.com/Optum
- type: Blog
  url: https://www.optum.com/en/newsroom.html
x-enrichment:
  date: '2026-08-14'
  status: enriched
  artifacts_added: 139
  pass: local-v1

Optum

Kin Score

APIs 9

Optum Medical Network Eligibility and Claims API

Optum Real (Medical) API

Optum Real for Dental API

Optum Pharmacy Solutions API

Optum Payment and Reimbursement API

Optum Insight Platform (Platform and Interoperability) API

Optum Analytics and Insights API

Optum API Tools — Security and Authorization

Optum Interoperability APIs (CMS Patient Access)

Pricing Plans 1

Optum Plans Pricing