UnitedHealthcare

opencollection: 1.0.0
info:
  name: UnitedHealthcare Provider API
  version: '1.0'
request:
  auth:
    type: bearer
    token: '{{bearerToken}}'
items:
- info:
    name: Eligibility
    type: folder
  items:
  - info:
      name: UnitedHealthcare Real-Time Eligibility Check
      type: http
    http:
      method: POST
      url: https://api.uhcprovider.com/eligibility/v1/real-time
      body:
        type: json
        data: '{}'
    docs: Perform a real-time pre-service eligibility and benefit verification for a UnitedHealthcare member. Returns coverage
      details, deductibles, copays, and benefit limits for a specific service type and date of service.
  - info:
      name: UnitedHealthcare Real Patient Benefit Check
      type: http
    http:
      method: POST
      url: https://api.uhcprovider.com/eligibility/v1/patient-benefit-check
      body:
        type: json
        data: '{}'
    docs: Check specific patient benefit details for a given service including covered benefits, cost-sharing information,
      network status, and utilization management requirements.
- info:
    name: Claims
    type: folder
  items:
  - info:
      name: UnitedHealthcare Real Claim Pre-Check
      type: http
    http:
      method: POST
      url: https://api.uhcprovider.com/claims/v1/pre-check
      body:
        type: json
        data: '{}'
    docs: Validate a claim before submission to identify potential issues including missing information, coverage gaps, authorization
      requirements, and billing edits. Reduces claim denials and accelerates payment.
  - info:
      name: UnitedHealthcare Real Claim Inquiry
      type: http
    http:
      method: POST
      url: https://api.uhcprovider.com/claims/v1/inquiry
      body:
        type: json
        data: '{}'
    docs: Retrieve the status and details of submitted claims including payment information, denial reasons, adjustment codes,
      and explanation of benefits data for a member or provider.
- info:
    name: Prior Authorization
    type: folder
  items:
  - info:
      name: UnitedHealthcare Real Prior Auth Check
      type: http
    http:
      method: POST
      url: https://api.uhcprovider.com/prior-auth/v1/check
      body:
        type: json
        data: '{}'
    docs: Check if a prior authorization or referral is required for a specific service and procedure, and determine the authorization
      status for a UnitedHealthcare member.
- info:
    name: Providers
    type: folder
  items:
  - info:
      name: UnitedHealthcare Provider Demographics
      type: http
    http:
      method: GET
      url: https://api.uhcprovider.com/providers/v1/demographics
      params:
      - name: npi
        value: ''
        type: query
        description: National Provider Identifier (NPI) for the provider
      - name: state
        value: ''
        type: query
        description: Two-letter state code to filter results
    docs: Retrieve demographic and credentialing information for healthcare providers in the UnitedHealthcare network, including
      contact details, specialties, network participation, and accepting new patients status.
bundled: true