Transparency
With real-time transparency into a patient’s eligibility data and coding validation, providers can improve the patient experience and reduce avoidable claim denials.
Efficiency
Access data across multiple payers through a single integration, relieving administrative burden and improving claim processing workflows.
Administrative cost savings
More accurate claim submission reduces administrative costs and expedites reimbursement.
Included modules
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Optum Real Pre-Service Eligibility API
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Optum Real Claim Pre-Check API
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Optum Real Claim Inquiry API
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Optum Real Patient Benefit Check API
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Optum Real Claim Actions API
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Optum Real Prior Auth/Referral Actions API
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Optum Real Document Search API
Patient in-office visit – Check-in
Optum Real Pre-Service Eligibility API
With Real Pre-Service Eligibility, providers can submit real-time eligibility inquiries to payers before the patient’s visit. Through a centralized API, you can access real-time patient eligibility information across multiple payers within your existing EHR system. Spend less time chasing information and more time delivering a high-quality experience for your patients.
Real Pre-Service Eligibility includes:
• Eligibility information including patient demographic information, plan-level cost shares, plan coverage details and insurance details
• Coordination of benefits including primacy and coverage details for each payer plan
• Image of a patient’s insurance ID card
• Provider in- and out-of-network status
Real Pre-Service Eligibility is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Patient in-office visit – Appointment
Optum Real Patient Benefit Check API
With Real Patient Benefit Check, providers can validate patient benefits as well as prior authorization and referral requirements before care is delivered. This centralized API allows you to reduce denials and give patients clear answers about what’s covered and what they’ll owe before they receive care, reducing surprise bills and improving patient satisfaction.
Real Patient Benefit Check includes:
• Referral requirements and if one already exists for specific service
• Benefits covered by CPT code including limits, restrictions and exceptions*
• Cost share details for in-network and out-of-network services*
*Capability is not currently available and is planned for future release.
Real Patient Benefit Check is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Optum Real Prior Auth/Referral Actions API
With Real Prior Auth/Referral Actions, providers can submit, track and manage prior authorization and referral requests. By streamlining prior authorization and referral requests before care is delivered, this centralized API helps providers reduce denials and decrease surprise bills for patients.
Real Prior Auth/Referral Actions includes:
• Prior authorization submission and status
• Referral submission and status
• Supporting documentation submission
Real Prior Auth/Referral Actions is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Patient in-office visit – Checkout
Optum Real Claim Pre-Check API
With Real Claim Pre-Check, providers can submit real-time claim inquiries to payers prior to treatment. Through a centralized API, you can access claim processing information — like eligibility and prior authorization requirements — across multiple payers in real time. This allows you to identify and prevent denials before they occur.
Real Claim Pre-Check includes:
• X12 claim validation (HIPAA)
• Membership coverage eligibility for the date of service
• Coordination of benefits including primacy and coverage details
• Prior authorization requirements and status
• Adherence to payment and medical policies
Real Claim Pre-Check is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Claim submission and adjudication in real time – Billing and reconciliation
Optum Real Claim Actions API
With Real Claims Actions, providers can submit more accurate claims, reconsideration requests, appeals and supporting documentation. This centralized API gives you access to payer claim processing information in real time to validate claims prior to submission, which may help identify and reduce the likelihood of denials before they occur. It also streamlines and enhances the efficiency of the submission process so you can spend less time on administrative tasks and more time with patients.
Real Claim Actions includes:
• X12 claim validation (HIPAA)
• Membership coverage eligibility for the date of service
• Coordination of benefits including primacy and coverage details
• Prior authorization requirements and status
• Claim submission
• Reconsideration request and appeal submission
• Supporting documentation submission
Real Claim Actions is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Optum Real Claim Inquiry API
With Real Claim Inquiry, providers can receive real-time status updates on submitted claims. This centralized API gives you access to claim information — such as summaries, details and status updates — in real time, allowing you to make informed decisions regarding reconsideration requests and appeals more quickly to help reduce administrative burden.
Real Claim Inquiry includes:
• Claim summaries and details
• Status at the claim and service level
• Available actions for reconsiderations and appeals at the service level
• Download of associated documents
Real Claim Inquiry is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Claim submission and adjudication in real time – Payment
Optum Real Document Search API
With Real Document Search, providers can securely retrieve claim- and payment-related documents, offering quick access to key information for reconciliation, review, and recordkeeping. This centralized API provides access to documents such as EDI 835, provider remittance advice (PRA) notices, explanations of benefits (EOB), provider letters and virtual card payment (VCP) documents. This can help providers locate and retrieve files more efficiently, helping reduce time spent on administrative tasks and enhance the provider experience.
Real Document Search includes:
• Document metadata retrieval
• Secure document download
Real Document Search is currently live with UnitedHealthcare. Additional payers are planned for future development. Please visit the developer portal for a list of supported payer IDs.
Optum Real webinar: Unlock real collaboration between payers and providers
Others say real time. We mean it. Discover how Optum Real APIs allow payers and providers to communicate faster than ever. With real-time data integration, provider service companies can help streamline workflows, reduce denials and deliver better patient experiences.
Sell sheet
Transforming the revenue cycle for your customers
Optum® Real is changing the revenue cycle as we know it. Through real-time, automated exchange of enriched eligibility, claims and payment data, your providers can get the information they need before care is delivered — not days later.
Developer Resources
Try before subscribe – Request access to sandbox credentials for all Optum Real APIs
Q: How can I test the Real APIs before subscribing?
A: You can request access to the AI Marketplace sandbox environment to test sample API responses by visiting this page, scrolling down to Developer Resources and clicking “Request sandbox.” After you submit the form, you'll receive credentials that allow you to integrate your software with the sandbox environment. You can use these credentials to test the APIs in our interactive environment Try It page or use an application like Postman. Please note: The pre-subscription sandbox will only return responses based on preloaded data until your Real API subscription status is “subscribed.”
Q: Can I subscribe to multiple Real APIs?
A: Yes, you can subscribe to one or more Real APIs. The subscriptions will align to the same set of API credentials whether they are ordered at the same time or not.
Q: What information do I need to create an AI Marketplace account?
A: Please use your organization’s company name listed in box 1 on its active W-9 form filed with the IRS, and make sure it is an exact match. Mismatched company names – including capitalization inconsistencies, spaces, special characters or abbreviations – may lead to order processing issues. The same company name will appear auto-populated in the billing information section when subscribing. If you require any changes to your company name, please reach out to MarketplaceSupport@optum.com.
Q: What payers do the Real APIs cover?
A: The Real APIs are currently live with UnitedHealthcare. Additional payers may be added in the future. For a listing of payer ID coverage, for each API, please refer to the Optum Real overview page in the developer portal.
Q: Can software vendors subscribe to the Real APIs on behalf of their provider clients?
A: Yes. Once the API subscription is implemented, the software vendor's account administrator will be contacted for their provider clients' billing TINs so they can be associated with the active account subscription.
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