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API

Prior Authorization Inquiry

Prior Authorization Inquiry API is a public API that accepts prior authorization inquiry requests in the standard form of EDI-X12 278X215 payloads, formatted in JSON for HTTP request, and returns EDI-X12 payer response to the consumer. Our API makes prior authorization inquiry more accessible to developers and allows providers' systems to expand their functionality while efficiently returning the payer status accurately.

  • Prior Authorization Inquiry API is a cloud-native continuously deployable API that can be plugged into a multitude of consuming services or any system that has internet access.
  • The Authorization Inquiry API supports an expansive set of EDI and portal connections. You can send a request via JSON or EDI and the request will be routed to the correct payer through the clearinghouse. The authorization response from the payer will be returned in either EDI or JSON.

Reduce Claim Rejections

Performing prior authorization reduces backend claim rejections, which has been the top causes of denials in claims. Utilizing our API can improve accuracy and efficiency, while reducing administrative costs and claim denials.

Reduce Patient Delay

Obtaining the prior authorization denial/approval result early on can give assurance to your patients. Providing early notification of authorization denial to the patient can help their rescheduling process and can establish proper communication with the referring provider to collaborate for your patient care.

Rapid Implementation

Authorization implementations typically require a VPN connection and interface engine. This Authorization API will reduce your organization’s time to implement authorization functionality by integrating directly over a REST API.

Developer Resources

Prior Authorization Inquiry API

API Documentation
Request Sandbox

Frequently Asked Questions

Q: Which payers can I submit prior authorization requests to?

A: The payer list can be found here: https://community.changehealthcare.com/viewdocument/clearance-patient-access-suite-paye-1?CommunityKey=ac64ad08-ce3f-446b-a3cd-f1011f0dd5cb&tab=librarydocuments

Prior authorization requests can be submitted to any payer that has a value in the Authorization Verification Inquiry Connection column.

Q: Do you have a sandbox that I can test before signing a contract?

A: We do! You can use our Sandbox environment even before signing a contract.  It requires a separate set of secure credentials which you can obtain from your Optum representative. After receiving your client_id and client_secret for our Sandbox environment, you can test the API in our interactive documentation.  The interactive documentation can be found by following the API Documentation link in the Developer Resources section above.

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