Eligibility

commercialv3

Real-time healthcare eligibility and benefits verification. Confirm member coverage, copay, deductible, and out-of-pocket balances before service delivery using 270/271 transactions.

Send live requests to the sandbox environment. Requests are proxied through the portal server.

Endpoint

Headers

Body Parameters

submitterTransactionIdentifierstring

BHT03

controlNumber*string

Segment: ISA, Element: ISA13, Notes: Required, Interchange Control Number - must be exactly 9 positive unsigned numeric characters.

tradingPartnerServiceIdstring

Loop: 2100A Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI

tradingPartnerNamestring

Loop: 2100A, Segment: NM1, Element: NM103, Notes: organizational name

portalUsernamestring

Loop: 2100B, Segment: REF, Element: REF02, Notes: User Identification REF01=JD

portalPasswordstring

Loop: 2100B, Segment: REF, Element: REF02, Notes: Personal Identification Number (PIN) REF01=4A

curl -X POST \
  'https://sandbox-apigw.optum.com/medicalnetwork/eligibility/v3/'
  -H 'Accept: application/json'

Send a request to see the response here.