UnitedHealthcare

UnitedHealthcare is one of the largest health insurance providers in the United States, offering employer-sponsored health benefits, individual and family plans, Medicare and Medicaid plans, and managed care services. UnitedHealthcare provides APIs for healthcare providers through the UHC API Marketplace for eligibility verification, claims management, and prior authorization, and FHIR R4-compliant Interoperability APIs for patient data access and provider directory services per CMS mandates.

UnitedHealthcare publishes 7 APIs on the APIs.io network, including Claims API, Eligibility API, Formulary API, and 4 more. Tagged areas include Health Insurance, Healthcare, FHIR, Claims, and Eligibility.

The UnitedHealthcare catalog on APIs.io includes 2 JSON-LD contexts and 2 Spectral governance rulesets.

UnitedHealthcare’s developer surface includes authentication and 4 more developer resources.

🌐 Visit website 📡 Source on GitHub

44.4/100 developing ▬ flat Agent 31/100 agent aware Full breakdown ↓
scored 2026-08-05 · rubric v0.9.1

AccessFreemiumSelf serve⚡ Free to try

7 APIs

Health InsuranceHealthcareFHIRClaimsEligibility

Kin Score

Kin Score How this is scored →
scored 2026-08-05 · rubric v0.9.1

Composite quality — 44.4/100 · developing

Contract Quality 18.4 / 25

Developer Ergonomics 2.2 / 20

Commercial Clarity 7.9 / 20

Operational Transparency 4.8 / 13

Governance 7.0 / 12

Discoverability 7.4 / 10

Agent readiness — 31/100 · agent aware

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 0 / 8

Request/Response Examples 0 / 7

Rate-Limit Signaling 7 / 7

Typed Event Surface 0 / 6

Agent Skills 0 / 5

Well-Known Catalog 0 / 4

Consent & Bot Identity 0 / 3

A2A Agent Card 0 / 8

Dry-Run / Simulate Mode 0 / 4

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/unitedhealthcare: 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 7

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

Rate Limits 1

Documented rate limits and quota policies.

Unitedhealthcare Rate Limits

5 limits

RATE LIMITS

FinOps 1

Cost, billing, and metering signals for API financial operations.

JSON Schema 13

Standalone JSON Schema definitions for this provider's data models.

Scroll for all 13

JSON Structure 13

JSON Structure definitions describing this provider's data shapes.

Scroll for all 13

Examples 8

Example request and response payloads for these APIs.

Scroll for all 8

Agent Surfaces 1

MCP servers, agent skills, and machine-readable catalogs

AgenticAccess

AgenticAccess

Build 1

SDKs, sample code, and the tooling you integrate with

GitHubOrganization

GitHubOrganization

Access & Security 2

Authentication, authorization, and security posture

DomainSecurity

DomainSecurity

Authentication

Authentication

Company 1

The organization behind the API

LinkedIn

Source (apis.yml)

aid: unitedhealthcare
url: https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/apis.yml
name: UnitedHealthcare
description: UnitedHealthcare is one of the largest health insurance providers in the United States, offering employer-sponsored
  health benefits, individual and family plans, Medicare and Medicaid plans, and managed care services. UnitedHealthcare provides
  APIs for healthcare providers through the UHC API Marketplace for eligibility verification, claims management, and prior
  authorization, and FHIR R4-compliant Interoperability APIs for patient data access and provider directory services per CMS
  mandates.
tags:
- Health Insurance
- Healthcare
- FHIR
- Claims
- Eligibility
kind: company
accessModel:
  pricing: freemium
  onboarding: self-serve
  trial: false
  try_now: true
  public: false
  label: Freemium · Self-serve signup
  confidence: high
  source:
  - plans
  - authentication
  generated: '2026-07-22'
  method: derived
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/icons/unitedhealthcare.png
access: 3rd-Party
created: '2025-03-01'
modified: '2026-05-19'
position: Consuming
specificationVersion: '0.19'
common:
- type: AgenticAccess
  url: agentic-access/unitedhealthcare-agentic-access.yml
- type: DomainSecurity
  url: security/unitedhealthcare-domain-security.yml
- type: Authentication
  url: authentication/unitedhealthcare-authentication.yml
- type: GitHubOrganization
  url: https://github.com/UnitedHealthCare
- type: LinkedIn
  url: https://www.linkedin.com/company/unitedhealthcare
apis:
- aid: unitedhealthcare:unitedhealthcare-claims-api
  name: UnitedHealthcare Claims API
  description: Claim pre-check, submission, and inquiry
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Claims
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-claims-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
- aid: unitedhealthcare:unitedhealthcare-eligibility-api
  name: UnitedHealthcare Eligibility API
  description: Real-time eligibility and benefit verification
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Eligibility
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-eligibility-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
- aid: unitedhealthcare:unitedhealthcare-formulary-api
  name: UnitedHealthcare Formulary API
  description: Drug formulary and coverage information
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Formulary
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-formulary-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
- aid: unitedhealthcare:unitedhealthcare-patient-access-api
  name: UnitedHealthcare Patient Access API
  description: FHIR R4 Patient Access API for member health data
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Patient Access
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-patient-access-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
- aid: unitedhealthcare:unitedhealthcare-prior-authorization-api
  name: UnitedHealthcare Prior Authorization API
  description: Prior authorization and referral actions
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Prior Authorization
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-prior-authorization-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
- aid: unitedhealthcare:unitedhealthcare-provider-directory-api
  name: UnitedHealthcare Provider Directory API
  description: FHIR R4 Provider Directory API for network information
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Provider Directory
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-provider-directory-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
- aid: unitedhealthcare:unitedhealthcare-providers-api
  name: UnitedHealthcare Providers API
  description: Provider demographics and directory
  humanURL: https://apimarketplace.uhcprovider.com/#/
  baseURL: https://api.uhcprovider.com
  tags:
  - Providers
  properties:
  - type: OpenAPI
    url: openapi/unitedhealthcare-providers-api-openapi.yml
  - type: Documentation
    url: https://apimarketplace.uhcprovider.com/#/
  - type: Schema
    url: json-schema/provider-eligibility-response-schema.json
  - type: Schema
    url: json-schema/provider-claim-inquiry-response-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - type: Examples
    url: examples/provider-eligibility-response-example.json
  - type: Documentation
    url: https://www.uhc.com/legal/interoperability-apis
  - type: Schema
    url: json-schema/interoperability-fhir-bundle-schema.json
  - type: Schema
    url: json-schema/interoperability-fhir-patient-schema.json
  - type: JSONLDContext
    url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  - type: Examples
    url: examples/interoperability-fhir-bundle-example.json
features:
- name: Real-Time Eligibility Verification
  description: Verify UnitedHealthcare member eligibility and benefits in real time at the point of care, reducing claim denials
    and improving patient financial transparency.
- name: Claim Pre-Check
  description: Validate claims before submission to identify errors, missing authorizations, and billing issues that would
    cause denials, accelerating payment cycles.
- name: Prior Authorization Check
  description: Determine prior authorization requirements for procedures and check existing authorization status to streamline
    clinical workflows.
- name: FHIR R4 Patient Access
  description: CMS-mandated FHIR R4 APIs enabling patients and authorized applications to access claims history, coverage
    data, and clinical information.
- name: Provider Directory
  description: FHIR R4 Provider Directory implementing Da Vinci PDex Plan Net IG for searching UnitedHealthcare network providers,
    organizations, and locations.
- name: Drug Formulary
  description: FHIR-based formulary API providing drug coverage tier information, prior authorization requirements, and quantity
    limits for prescription medications.
- name: Claims Inquiry
  description: Real-time claim status inquiry returning payment details, denial reasons, adjustment codes, and explanation
    of benefits data.
useCases:
- name: Point-of-Care Eligibility
  description: Verify patient UnitedHealthcare coverage and benefits at check-in using the real-time eligibility API to collect
    accurate copays and reduce billing errors.
- name: Revenue Cycle Management
  description: Integrate claim pre-check and claim inquiry APIs into practice management systems to automate claim validation
    and track payment status.
- name: Prior Authorization Workflows
  description: Embed prior authorization checking in clinical workflows to immediately determine if approval is needed before
    scheduling procedures or prescribing medications.
- name: Patient Portal Integration
  description: Enable patient portals to display claims history, coverage details, and EOBs using the FHIR Patient Access
    API for transparent member engagement.
- name: Provider Search Applications
  description: Build provider search tools and care coordination apps using the FHIR Provider Directory API to find in-network
    physicians, specialists, and facilities.
- name: Formulary Management
  description: Integrate the Formulary API into EHR and e-prescribing workflows to check drug coverage tiers and authorization
    requirements at point of prescribing.
integrations:
- name: Epic Systems
  description: UnitedHealthcare APIs integrate with Epic EHR for real-time eligibility verification, prior authorization,
    and FHIR-based data exchange.
- name: Cerner/Oracle Health
  description: FHIR R4 Interoperability APIs integrate with Cerner for patient data access and provider directory services.
- name: Change Healthcare
  description: Provider APIs complement Change Healthcare clearinghouse services for comprehensive claims management and eligibility
    verification.
- name: Availity
  description: UnitedHealthcare participates in Availity's real-time eligibility and claims network providing additional access
    pathways for providers.
artifacts:
  openapi:
  - name: UnitedHealthcare Provider API
    url: openapi/unitedhealthcare-provider-api-openapi.yml
  - name: UnitedHealthcare Interoperability API
    url: openapi/unitedhealthcare-interoperability-api-openapi.yml
  jsonSchema:
  - url: json-schema/provider-eligibility-request-schema.json
  - url: json-schema/provider-eligibility-response-schema.json
  - url: json-schema/provider-benefit-check-request-schema.json
  - url: json-schema/provider-benefit-check-response-schema.json
  - url: json-schema/provider-claim-pre-check-request-schema.json
  - url: json-schema/provider-claim-pre-check-response-schema.json
  - url: json-schema/provider-claim-inquiry-request-schema.json
  - url: json-schema/provider-claim-inquiry-response-schema.json
  - url: json-schema/provider-prior-auth-check-request-schema.json
  - url: json-schema/provider-prior-auth-check-response-schema.json
  - url: json-schema/provider-provider-demographics-schema.json
  - url: json-schema/interoperability-fhir-bundle-schema.json
  - url: json-schema/interoperability-fhir-patient-schema.json
  jsonStructure:
  - url: json-structure/provider-eligibility-response-structure.json
  - url: json-structure/provider-claim-inquiry-response-structure.json
  - url: json-structure/provider-provider-demographics-structure.json
  - url: json-structure/interoperability-fhir-bundle-structure.json
  - url: json-structure/interoperability-fhir-patient-structure.json
  jsonLd:
  - url: json-ld/unitedhealthcare-provider-api-context.jsonld
  - url: json-ld/unitedhealthcare-interoperability-api-context.jsonld
  examples:
  - url: examples/provider-eligibility-response-example.json
  - url: examples/provider-claim-inquiry-response-example.json
  - url: examples/provider-prior-auth-check-response-example.json
  - url: examples/interoperability-fhir-bundle-example.json
  - url: examples/interoperability-fhir-patient-example.json
  spectralRules:
  - url: rules/unitedhealthcare-spectral-rules.yml
  capabilities:
    shared:
    - url: capabilities/shared/provider-api.yaml
    - url: capabilities/shared/interoperability-api.yaml
    workflows:
    - url: capabilities/provider-operations.yaml
    - url: capabilities/patient-data-access.yaml
  vocabulary:
  - url: vocabulary/unitedhealthcare-vocabulary.yaml
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com

UnitedHealthcare

APIs 7

Open Collections 2

Pricing Plans 1