Application Programming Interface (API)

Our API solutions allow you to electronically receive detailed data on the status of claims and member eligibility and benefits. Information returned emulates the information on Link and complements Electronic Data Interchange (EDI) transactions. Data can be transferred directly to your practice management or hospital information system. API helps reduce phone calls and paper handling, while contributing to a smoother workflow.

API Types:

Claim Status

  • Status of claim
  • Amount and date paid
  • Payment number
  • Claim and line-level detail
  • COB information
  • UnitedHealthcare-specific adjustment codes
  • Reconsideration details
  • Reconsiderations with attachments
  • Appeals with attachments

Eligibility and Benefits

  • Member attributes
  • Policy/group number
  • Plan type
  • Plan deductibles: Individual/family year to date, remaining, plan amount
  • Out of pocket: Individual/family year to date, remaining, plan amount
  • Coverage dates
  • Primary care provider
  • Referral required
  • CPT code lookup for authorization requirement (coming soon)

Paperless (Claim Correspondence)

  • Claim and appeal letters
  • Additional claim information requests
  • Updates to patient responsibility
  • Payment recovery letters

Prior Authorization and Notification (coming soon)

  • Quick code lookup
  • Case submission with attachments
  • Check status
  • Case update