# Optum

**Canonical:** https://apis.io/providers/optum/  
**Website:** https://www.optum.com/  
**APIs profiled:** 9

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.

## Kin Score — 57.8 / 100 (strong)

Scored 2026-08-17 under rubric 0.11.0. Trend: rising (+26.0 from 31.8).

| Facet | Score |
|---|---|
| Discoverability | 92.6 |
| Contract Quality | 59.5 |
| Governance | 11.5 |
| Operational Transparency | 55.3 |
| Developer Ergonomics | 65.2 |
| Commercial Clarity | 52.6 |

Regulatory layer — **Health**: 66.3 (matched via tags).

## Agent readiness — 64.0 (agent-ready)

| Dimension | Value |
|---|---|
| Spec Presence | yes |
| Agentic Access | yes |
| MCP Server | no |
| Auth Clarity | yes |
| Idempotency | no |
| Error Semantics | verified |
| OpenAPI Examples | partial |
| Rate Limit Signal | documented |
| Event Surface Described | yes |
| Agent Skills | yes |
| Well Known Catalog | yes |
| Consent Identity | yes |
| Agent Card | no |
| Dry Run Mode | no |

## Access

Self-serve signup — onboarding: self-serve, pricing: unknown, trial: no (confidence: medium).

## APIs (9)

- **Optum Medical Network Eligibility and Claims API** — 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 ...
- **Optum Real (Medical) API** — 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...
- **Optum Real for Dental API** — 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 ...
- **Optum Pharmacy Solutions API** — 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.
- **Optum Payment and Reimbursement API** — Payer enrollment and document tracking for the Optum intelligent clearinghouse: PES payer enrollments, EDI enrollment, and a file and document tracking API for following submiss...
- **Optum Insight Platform (Platform and Interoperability) API** — Optum Insight Platform services published on gateway.optuminsightplatform.com: NCC data acquisition, a code-search core service, CMS and Optum common physician and facility prov...
- **Optum Analytics and Insights API** — 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 la...
- **Optum API Tools — Security and Authorization** — 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...
- **Optum Interoperability APIs (CMS Patient Access)** — 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 phy...

## Agentic access (1)

- **Optum Agentic Access** — 483 operations · 122 acting · 3 human-in-the-loop

## Security (3)

- **Optum Authentication** — oauth2 · 2 schemes
- **Optum Domain Security** — TLSv1.3 · HSTS · DNSSEC · DMARC
- **Optum Vulnerability Disclosure** — security.txt · contact published

## Plans (1)

- **Optum Plans Pricing**

## 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

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Profiled by [API Evangelist](https://apievangelist.com) and published on [APIs.io](https://apis.io/providers/optum/). Scores are computed from the provider's own public artifacts under a published rubric.