Optum Institutional Claims API is one of 166 APIs that Optum publishes on the APIs.io network, described by a machine-readable OpenAPI specification.
Tagged areas include Institutional Claims. 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 4 paths,
and defines 71 schemas.
It is described by OpenAPI 3.2.0, at version V1.
Requests are made against a single base URL, https://sandbox-apigw.optum.com.
4 operations4 paths71 schemas4 POST
Metadata
The identity and technical contract details declared by the specification.
Specification
OpenAPI 3.2.0
API Version
V1
Base URL
https://apigw.optum.com/medicalnetwork/
Authentication
HTTP Bearer
Resource Areas
1
Authentication & Security 1
Optum Institutional Claims API declares
1 security scheme
for authenticating requests.
It accepts HTTP bearer tokens (JWT) (bearer-key).
Paths & Operations 4
Across 4 paths, the API surfaces 4 operations — 4 POST. Each is listed below with its method, path, parameters, and response codes.
The contract defines 71 schemas that model the data the API accepts and returns. The most detailed are ClaimInformation (40 properties), ServiceLine (25 properties), OtherSubscriberInformation (23 properties), MedicareInpatientAdjudication (19 properties). Each schema is shown below with its type and property counts.
ServiceLine
object
Loop: 2400, 2410, 2420A, 2420C, 2420D and 2430
25 properties2 required
MedicareInpatientAdjudication
object
Loop: 2320, Segment: MIA, Notes: Medical inpatient claim information
19 properties1 required
ServiceFacilityLocation
object
Loop: 2310E
5 properties2 required
Receiver
object
Loop: 1000B
2 properties1 required
ClaimDateInformation
object
5 properties2 required
PatientReasonForVisit
object
2 properties2 required
LineAdjudicationInformation
object
12 properties5 required
InstitutionalService
object
Loop: 2400, Segment: SV2
9 properties4 required
LineAdjustmentInformation
object
Loop 2430, Segment: CAS
11 properties7 required
ClaimPricingInformation
object
Loop 2400, Segment: HCP
15 properties2 required
ExternalCauseOfInjury
object
3 properties2 required
ClaimInformation
object
Loop: 2000B, 2000C and 2300
40 properties11 required
OtherProcedureInformation
object
3 properties2 required
AdmittingDiagnosis
object
2 properties2 required
Address
object
N3 and N4
7 properties2 required
ConditionInformation
object
1 property1 required
OtherPayerOperatingPhysician
object
REF
1 property1 required
MedicareOutpatientAdjudication
object
Loop: 2320, Segment: MOA, Notes: Medical outpatient claim information
5 properties
ContactInformation
object
PER
5 properties1 required
DiagnosisRelatedGroupInformation
object
1 property1 required
ClaimCodeInformation
object
3 properties2 required
ServiceLineReferenceInformation
object
Loop 2400, Segment: REF
3 properties
RawX12Request
object
1 property
Submitter
object
Loop: 1000A
3 properties2 required
Response
object
11 properties
Error
object
Error
6 properties
Subscriber
object
Loop: 2000B, used in 2000C when dependent not present
13 properties3 required
OccurrenceSpanInformation
object
3 properties3 required
EpsdtReferral
object
2 properties2 required
Dependent
object
Loop: 2000B and 2000C
9 properties5 required
Payer
object
2 properties
ClaimAdjustment
object
2 properties1 required
ClaimNotes
object
Loop 2300; Segment: NTE
15 properties
PrincipalProcedureInformation
object
HI
3 properties2 required
OccurrenceInformation
object
2 properties2 required
referring
object
Loop: 2310F
17 properties1 required
billing
object
Loop: 2000A
17 properties1 required
PayToAddressName
object
Loop: 2010AB Billing Provider Pay To Address Name
2 properties
ClaimContractInformation
object
6 properties4 required
ServiceLineSupplementalInformation
object
Loop: 2400, Segment: PWK
3 properties2 required
OperatingPhysician
object
Loop: 2420A, Segment: REF
8 properties1 required
ServiceLineDateInformation
object
Loop: 2400, Segment: DTP
4 properties
OtherPayerBillingProvider
object
Loop: 2330I, Notes: Information regarding other payer billing provider
1 property1 required
ServiceLineProvider
object
NM1 and REF
18 properties1 required
rendering
object
Loop: 2310D
17 properties1 required
ClaimSupplementalInformation
object
Loop: 2400, Segment: PWK
13 properties
Failure
object
2 properties
ReferenceIdentification
object
2 properties2 required
OtherPayerOtherOperatingPhysician
object
REF
1 property1 required
OtherDiagnosisInformation
object
3 properties2 required
InstitutionalClaimsRequest
object
InstitutionalClaimsRequest
19 properties6 required
LinePricingInformation
object
Loop 2400, Segment: HCP
14 properties2 required
PayToPlanName
object
Loop: 2010AC
8 properties1 required
EditResponse
object
13 properties
OtherPayerServiceFacilityLocation
object
Loop: 2330F, Notes: Information regarding other payer service facility location
1 property1 required
OtherPayerRenderingProvider
object
REF
1 property1 required
OtherPayerName
object
Loop: 2330B, Notes: Information regarding other payer
11 properties3 required
OtherSubscriberName
object
Loop: 2330A, Notes: Information regarding other subscriber
10 properties4 required
ClaimAdjustmentDetails
object
Loop: 2420, Segment: CAS
3 properties2 required
otherOperatingPhysician
object
LOOP: 2310C
8 properties1 required
ResponseMeta
object
meta data about the request
5 properties
OtherSubscriberInformation
object
Loop: 2320
23 properties7 required
OtherPayerAttendingProvider
object
Loop: 2330C, Notes: Information regarding other attending provider
1 property1 required
OtherPayerReferringProvider
object
REF
1 property1 required
operatingPhysician
object
Loop 2310B
8 properties1 required
ReportInformation
object
Loop: 2300, 2400; Segment: PWK
3 properties3 required
ClaimReference
object
ClaimReference
8 properties
DrugIdentification
object
Loop 2410, Segment: LIN
5 properties3 required
attending
object
Loop: 2310A
17 properties1 required
ValueInformation
object
2 properties2 required
PrincipalDiagnosis
object
HI
3 properties2 required
Specification
The full machine-readable OpenAPI contract behind this narrative.
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