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Optum

Optum Medical Network Eligibility and Claims API

RESTful JSON and native X12 EDI (270/271, 837P/837I, 276/277, 835) healthcare transaction APIs for real-time patient eligibility and coverage verification, enhanced eligibility with asynchronous coverage discovery, professional and institutional claim validation and submission, claim status inquiry, ERA and 277CA claim-response reports, prior authorization (X12 278), attachment submission/status/retrieval, and the payer directory with live payer outage data.

Documentation Provider Profile APIs.io OpenAPI GitHub

This API exposes 11 operations across 11 paths, and defines 7 schemas. It is described by OpenAPI 3.0.3, at version 2.2.0.

Requests are made against a single base URL, https://sandbox-apigw.optum.com.

11 operations 11 paths 7 schemas 1 DELETE5 GET1 PATCH3 POST1 PUT

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 3.0.3
API Version
2.2.0
Base URL
https://apigw.optum.com/medicalnetwork/
Authentication
OAuth 2.0
Resource Areas
1

Authentication & Security 1

Optum Medical Network Eligibility and Claims API declares 1 security scheme for authenticating requests. It supports OAuth 2.0 (Bearer) using the clientCredentials flow. By default, every request must be authenticated.

Paths & Operations 11

Across 11 paths, the API surfaces 11 operations — 1 DELETE, 5 GET, 1 PATCH, 3 POST, 1 PUT. Each is listed below with its method, path, parameters, and response codes.

Attachment 11
POST
/dentalnetwork/attachments/v1/CreateAttachment
Create attachment container
body → 201400403404422500502503
POST
/dentalnetwork/attachments/v1/AddAttachment
Add attachment files
body → 201400403404429500502503
PUT
/dentalnetwork/attachments/v1/{attachmentId}/UpdateAttachmentFile/{attachmentFileId}
Update attachment to container.
2 params body → 200400403404429500502503
PATCH
/dentalnetwork/attachments/v1/CommitAttachment/{attachmentId}
Commits the attachment container and files
1 param → 200400403404409412429500
GET
/dentalnetwork/attachments/v1/GetAttachmentbyId/{attachmentId}
Gets an attachment container.
1 param → 200400401403404429500502
GET
/dentalnetwork/attachments/v1/GetAttachmentList/{AttachmentId}
Get attachment files from container
1 param → 200400403404429500502503
DELETE
/dentalnetwork/attachments/v1/{attachmentId}/DeleteAttachmentFile/{attachmentFileId}
Delete attachment file
2 params → 200400403404412429500502
GET
/dentalnetwork/attachments/v1/GetAllParticipatingPayers
Get participating payers
→ 200400403404429500502503
GET
/dentalnetwork/attachments/v1/IsParticipatingPayer
Check participating payer by payer ID
1 param → 200400403404412429500502
GET
/dentalnetwork/attachments/v1/GetPayerBusinessRules/me
Get payer business rule
2 params → 200400401403404429500502
POST
/apip/auth/v2/token
To generate token.
body → 200400403404429500502503

Schemas 7

The contract defines 7 schemas that model the data the API accepts and returns. The most detailed are Attachment (51 properties), AttachmentFile (16 properties), ErrorResponse (7 properties), Version (6 properties). Each schema is shown below with its type and property counts.

Attachment
object
51 properties
AttachmentFile
object
16 properties
HttpVersionPolicy
integer
Link
object
4 properties
StringStringIEnumerableKeyValuePair
object
2 properties
Version
object
6 properties
ErrorResponse
object
Describes an error that occurred while processing the request.
7 properties

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

optum-dental-attachment-api-openapi.yml Raw ↑
#Eligibility#Claims#Claim Status#ERA#Prior Authorization#X12#Attachments#Payer Directory
← Back to O APIs
API Details
ID
optum:optum-medical-network-eligibility-and-claims-api
Base URL
https://apigw.optum.com/medicalnetwork/
Docs
https://developer.optum.com/eligibilityandclaims
Provider
Optum
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This is an independent, third-party profile of Optum Medical Network Eligibility and Claims 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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