Optum

aid: optum
name: Optum
description: Optum, part of UnitedHealth Group, is a health services and technology company that operates one of the largest
  medical and pharmacy networks in the United States. Its developer platform (developer.optum.com) exposes RESTful, JSON-
  and X12 EDI-based healthcare APIs for eligibility verification, professional and institutional claims validation and submission,
  claim status, ERA/remittance reports, prior authorization, attachments, payer directory, dental pre-care and claims, pharmacy
  solutions, and FHIR-based Data Access and Interoperability (Patient Access) endpoints. APIs are secured with OAuth2 client-credentials
  bearer tokens over TLS 1.2+, with free sandbox access, interactive "Try It" documentation, and downloadable OpenAPI specifications.
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: stub
x-tier-reason: portfolio-lead
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: '2026-07-20'
tags:
- Company
- Healthcare
- Health Insurance
- Claims
- Eligibility
- FHIR
- Interoperability
- Pharmacy
- EDI
- X12
- Payments
- Prior Authorization
apis:
- name: Optum Medical Network Eligibility and Claims API
  description: RESTful, JSON and X12 EDI (270/271, 837, 276/277, 835) healthcare transaction APIs for real-time patient eligibility
    and coverage verification, professional and institutional claim validation and submission, claim status inquiry, ERA/claim
    responses and reports, prior authorization, attachments, and payer list lookup.
  humanURL: https://developer.optum.com/eligibilityandclaims
  baseURL: https://apigw.optum.com/medicalnetwork/
  tags:
  - Eligibility
  - Claims
  - Claim Status
  - ERA
  - Prior Authorization
  - X12
  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
- name: Optum Data Access and Interoperability (FHIR) API
  description: FHIR R4-based Patient Access and interoperability APIs (Endpoint, Procedure, DocumentReference, ObservationVitalSigns,
    Immunization, and related resources) supporting CMS interoperability and patient data access requirements.
  humanURL: https://developer.optum.com/dataaccessandinteroperability
  baseURL: https://apigw.optum.com/
  tags:
  - FHIR
  - Interoperability
  - Patient Access
- name: Optum Real for Dental API
  description: Real-time dental data exchange APIs for pre-care estimates, eligibility, claims submission and inquiry, attachments
    with image intelligence, and ERA, with GraphQL options for select operations.
  humanURL: https://developer.optum.com/optumreal-dental
  baseURL: https://apigw.optum.com/dentalnetwork/
  tags:
  - Dental
  - Eligibility
  - Claims
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com
- FN: APIs.json
  email: info@apis.io
common:
- 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
x-enrichment:
  date: '2026-07-20'
  status: enriched
  artifacts_added: 9
  pass: local-v1