Application Programming Interface (API)

A new way to automate your data feeds. API is designed to help your organization improve efficiency, reduce costs and increase cash flow.

API is becoming the newest digital method in health care to distribute information to health care professionals and external organizations in a timely and effective manner. It’s not a UnitedHealthcare-only term or software. API is a common programming interface that interacts between multiple applications. Data is in real-time and can be programmed to be pulled repetitively to automate data feeds.

As a client, you can use API to exchange information from your database to UnitedHealthcare’s database and vice-versa, we then use this data to help you complete clinical activities and to improve how you work with us.

API Transaction Types

  • Eligibility and benefits
  • Prior authorizations
  • Referrals
  • Claim status and payments
  • Claim reconsiderations (with attachments)
  • Claim appeals (with attachments)
  • Documents (replacing paper correspondence)

For specific data returned in these APIs, refer to our Digital Solutions Comparison Guide or technical Reference Guides.

Why add API to your practice?

API is designed to help your organization improve efficiency, reduce costs and increase cash flow. Phone calls and paper handling decrease, while contributing to a smoother workflow with fewer interruptions. Automatic data feeds are created to pull information on a timetable you set, and transfer the data to your practice management system, proprietary software, portal, spreadsheets or any application you prefer.

Flexibility

  • Used by practices, facilities, health care systems, vendors, clearinghouses and revenue cycle management companies
  • Various levels of data are accessible for each API type. Choose those that that fit the needs of your organization.
  • APIs are available for many UnitedHealthcare payers and plans. Payer IDs are indicated on each API Guide.

Efficiency

  • Fill in gaps for information you may not be getting in your current data streams, such as electronic data interchange (EDI)
  • Share and distribute data throughout your practice more easily and efficiently
  • Streamline daily workflows and reduce staff time spent on manually retrieving information from the UnitedHealthcare Provider Portal

How to get started

API requires technical coordination with a health care professional or business partner’s IT department, vendor or clearinghouse. During the initial consultation, we review compatibility and API connectivity options.

When you’re ready to implement API, we provide direct onboarding and support in coordination with the Optum technical team. Once in production, we monitor API usage compared to call volumes to identify opportunities to further reduce incoming calls.  

For more information on API or to schedule a consultation, send us an email including your name, title, organization, email address and phone number.