Application Programming Interface (API)

Our API solutions allow you to electronically receive detailed data on the status of claims, member eligibility and benefits and paper correspondence. 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:

The following is a general list of information available through API and does not represent all data offered. Please review individual API guides for current information.

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 Letters
    • Claim acknowledgement
    • Additional claim information request
    • Patient responsibility update
    • Claim and appeal
    • Claim reconsideration response
  • Payment Documents
    • Provider remittance advice (PRA)
    • Payment summary
  • Prior Authorization Letters
    • Approval
    • Denial
    • Insufficient information submitted

Prior Authorization and Notification (coming soon)

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