OptumDeveloper

Professional Claims

commercialv3

The Professional Claims API takes the standard X12 EDI 837P transaction and translates it to JSON so it is more accessible to developers and easily integrated into users’ applications.

All endpoints
POST/medicalnetwork/professionalclaims/v3/raw-x12-validation

rawX12Validation

Claim Validation x12

Header Parameters

NameTypeDescription
X-CHC-ClaimSubmission-BillerIdstring—
X-CHC-ClaimSubmission-Usernamestring—
X-CHC-ClaimSubmission-Pwdstring—
X-CHC-ClaimSubmission-SubmitterIdstring—
X-CHC-TraceIdstring—
x-chng-trace-idstring—
Authorization*stringBearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>

Request Body*

application/json

object
x12string

For the x12 endpoint, the value should be a full 837 edi request.

Responses

200OK
object
statusstring

Status of claim

controlNumberstring

Transaction Set Control Number

tradingPartnerServiceIdstring

Payer ID

claimReferenceobject

Collection of info specific to a given claim

correlationIdstring

Claim correlation ID

submitterIdstring

Submitter ID for transaction

customerClaimNumberstring

Claim number

patientControlNumberstring

Control number for claim

timeOfResponsestring

Time of response for claim

claimTypestring

Claim Type

payerIDstring

Payer ID

formatVersionstring

Format version

rhclaimNumberstring
errorsarray

List of errors

httpStatusCodestring

Enum: 100 CONTINUE101 SWITCHING_PROTOCOLS102 PROCESSING103 EARLY_HINTS103 CHECKPOINT200 OK201 CREATED202 ACCEPTED203 NON_AUTHORITATIVE_INFORMATION204 NO_CONTENT205 RESET_CONTENT206 PARTIAL_CONTENT207 MULTI_STATUS208 ALREADY_REPORTED226 IM_USED300 MULTIPLE_CHOICES301 MOVED_PERMANENTLY302 FOUND302 MOVED_TEMPORARILY303 SEE_OTHER304 NOT_MODIFIED305 USE_PROXY307 TEMPORARY_REDIRECT308 PERMANENT_REDIRECT400 BAD_REQUEST401 UNAUTHORIZED402 PAYMENT_REQUIRED403 FORBIDDEN404 NOT_FOUND405 METHOD_NOT_ALLOWED406 NOT_ACCEPTABLE407 PROXY_AUTHENTICATION_REQUIRED408 REQUEST_TIMEOUT409 CONFLICT410 GONE411 LENGTH_REQUIRED412 PRECONDITION_FAILED413 PAYLOAD_TOO_LARGE413 REQUEST_ENTITY_TOO_LARGE414 URI_TOO_LONG414 REQUEST_URI_TOO_LONG415 UNSUPPORTED_MEDIA_TYPE416 REQUESTED_RANGE_NOT_SATISFIABLE417 EXPECTATION_FAILED418 I_AM_A_TEAPOT419 INSUFFICIENT_SPACE_ON_RESOURCE420 METHOD_FAILURE421 DESTINATION_LOCKED422 UNPROCESSABLE_ENTITY423 LOCKED424 FAILED_DEPENDENCY425 TOO_EARLY426 UPGRADE_REQUIRED428 PRECONDITION_REQUIRED429 TOO_MANY_REQUESTS431 REQUEST_HEADER_FIELDS_TOO_LARGE451 UNAVAILABLE_FOR_LEGAL_REASONS500 INTERNAL_SERVER_ERROR501 NOT_IMPLEMENTED502 BAD_GATEWAY503 SERVICE_UNAVAILABLE504 GATEWAY_TIMEOUT505 HTTP_VERSION_NOT_SUPPORTED506 VARIANT_ALSO_NEGOTIATES507 INSUFFICIENT_STORAGE508 LOOP_DETECTED509 BANDWIDTH_LIMIT_EXCEEDED510 NOT_EXTENDED511 NETWORK_AUTHENTICATION_REQUIRED

metaobject

meta data about the request

submitterIdstring

submitterId assigned to this request

senderIdstring

senderId assigned to this request

billerIdstring

billerId assigned to this request

traceIdstring

Unique Id assigned to each request by Optum

applicationModestring

Used by Optum to identify where this request can be found for support

editStatusstring
payerobject
payerNamestring
payerIDstring
editResponsesarray
failureobject
codestring
descriptionstring

Example Request

cURL
curl -X POST \
  'https://sandbox-apigw.optum.com/medicalnetwork/professionalclaims/v3/raw-x12-validation'