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Optum Coverage Discovery API

Create and retrieve asynchronous Coverage Discovery tasks. Coverage Discovery paths and add-ons are enabled per customer and are not included automatically. These endpoints support direct submission using either normalized eligibility data or JSON bodies containing X12 payloads, dry-run validation of enrolled discovery paths, polling for task status, and callback-based delivery of completed discovery results.

Optum Coverage Discovery API is one of 166 APIs that Optum publishes on the APIs.io network, described by a machine-readable OpenAPI specification.

Tagged areas include Coverage Discovery. The published artifact set on APIs.io includes an OpenAPI specification, an API reference, a getting-started guide, authentication docs, a changelog, and API documentation.

This API exposes 4 operations across 3 paths, and defines 8 schemas. It is described by OpenAPI 3.2.0, at version v0.2.0.

Requests are made against 2 base URLs: https://sandbox-apigw.optum.com, https://apigw.optum.com.

4 operations 3 paths 8 schemas 2 GET2 POST

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 3.2.0
API Version
v0.2.0
Base URL
https://apigw.optum.com/medicalnetwork/
Authentication
OAuth 2.0
Resource Areas
1

Authentication & Security 1

Optum Coverage Discovery API declares 1 security scheme for authenticating requests. It supports OAuth 2.0 (oAuth) using the clientCredentials flow, exposing 5 scopes.

  • oAuth — This API uses OAuth 2 with the clientcredentials grant flow. [More info](https://api.example.com/docs/auth)

Paths & Operations 4

Across 3 paths, the API surfaces 4 operations — 2 GET, 2 POST. Each is listed below with its method, path, parameters, and response codes.

Coverage Discovery 4

Create and retrieve asynchronous Coverage Discovery tasks. Coverage Discovery paths and add-ons are enabled per customer and are not included automatically. These endpoints suppor…

POST
/rcm/eligibility/v1/coverage-discovery
Submit new discovery task(s)
postDiscovery 2 params body → 2002022074004014034225XX
GET
/rcm/eligibility/v1/coverage-discovery
Find all discovery tasks
getAllDiscoveries 8 params → 2004014035XX
POST
/rcm/eligibility/v1/coverage-discovery/x12
Submit new discovery task(s) with EDI
postDiscoveryX12 2 params body → 2002022074004014034225XX
GET
/rcm/eligibility/v1/coverage-discovery/{id}
Find discovery task by ID
getDiscoveryById 2 params → 2004014034044225XX

Schemas 8

The contract defines 8 schemas that model the data the API accepts and returns. The most detailed are Transaction (13 properties), EligibilityRequest (11 properties), CoverageDiscoveryTask (11 properties), DiscoveryMultiStatusItem (3 properties). Each schema is shown below with its type and property counts.

EligibilityRequest
object
Standalone JSON representation of a standard 270 eligibility request. This schema is fully inlined into this spec so the API definition stands on its own.
11 properties 2 required
Error
array
The base object model for errors returned from the workflow
CoverageDiscoveryDryRunResult
object
Synchronous validation result returned when dryRun is true. No task record is created.
3 properties
DiscoveryAcceptedReceipt
object
Accepted task creation receipt.
2 properties
DiscoveryMultiStatusItem
object
Per-task result returned within a 207 response.
3 properties
Transaction
object
The base object model for the /transactions endpoints and the canonical model for Enhanced Eligibility
13 properties
CoverageDiscoveryDryRunPath
object
3 properties
CoverageDiscoveryTask
object
The base object model for the /coverage-discovery endpoints
11 properties

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

optum-coverage-discovery-api-openapi.yml Raw ↑

Other APIs Optum publishes across the network.

Optum Real (Medical) API
Optum Interoperability APIs (CMS Patient Access)
Optum Ambulance Fee Schedule APIs API
Optum Anesthesia Fee APIs API
Optum APC Calculator APIs API
Optum APC Cross Codes APIs API
Optum Apip API
Optum Application.wadl API
Optum Attachment API
Optum Attachment Document API
Optum Attachment Status API
Optum Attachment Submission API
Where this information came from

This is an independent, third-party profile of Optum Coverage Discovery API, published by API Evangelist. We do not operate, host, resell, or support these APIs, and we are not affiliated with or endorsed by the company unless stated above. Everything here is built from publicly available information — the company's own site, developer portal, documentation, public repositories, and the specifications it publishes for public use. Nothing is obtained by breaching a system, defeating an access control, or using credentials.

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