How AI is applied across API Evangelist and APIs.io. Read my AI disclosure →
API Evangelist API Evangelist
Discovery
Learnings
Guidance
Toolbox
Alignment
API Evangelist LLC

Optum Eligibility Requests API

Submit new real-time eligibility transactions. These endpoints accept either a normalized JSON request or a JSON request body with `x12` set to the X12 270 payload, and return a normalized JSON eligibility response. When a customer is enrolled in integrated Coverage Discovery, these operations may also return related discovery task links in the response headers.

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

Tagged areas include Eligibility Requests. 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 2 operations across 2 paths, and defines 5 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.

2 operations 2 paths 5 schemas 2 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 Eligibility Requests 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 2

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

Eligibility Requests 2

Submit new real-time eligibility transactions. These endpoints accept either a normalized JSON request or a JSON request body with x12 set to the X12 270 payload, and return a nor…

POST
/rcm/eligibility/v1
Submit a new eligibility request
postEligibility 3 params body → 2004004014035XX
POST
/rcm/eligibility/v1/real-time/x12
Submit a new X12 270 eligibility request
postEligibilityX12 4 params body → 2004004014035XX

Schemas 5

The contract defines 5 schemas that model the data the API accepts and returns. The most detailed are Transaction (13 properties), TransactionMedicare (11 properties), EligibilityRequest (11 properties), EligibilityRequestX12 (1 property). 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
TransactionMedicare
object
Medicare eligibility transaction derived from an X12 271 response (005010X279A1). This model represents the normalized API view of the payer response.
11 properties
Error
array
The base object model for errors returned from the workflow
Transaction
object
The base object model for the /transactions endpoints and the canonical model for Enhanced Eligibility
13 properties
EligibilityRequestX12
object
Real-time X12 request payload. The JSON field name is x12, and its value is the raw X12 270 request payload. The provider NPI in the X12 270 must be valid and…
1 property 1 required

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

optum-eligibility-requests-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 Eligibility Requests 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.

The Kin Score and Agent Readiness rating are independently calculated assessments of a company's public API artifacts, scored against a published rubric. They are not certifications, endorsements, security assessments, or audits.

Corrections, re-scores, and removal are free — no partnership or purchase required, and you do not need to justify the request. A removed company is recorded as unrated, never scored zero for having asked. Acknowledgement within one business day; removal within two.

info@apievangelist.com · Read the full data-sourcing policy →
On a security or compliance team? Put security in the subject line and you will get a person, not a form — we will tell you exactly which public URLs this profile was built from.