The Integrated Rules Institutional API is an enabling tool for making complex provider claims more accurate, and more likely to be accepted and adjudicated by the pay.
The Integrated Rules Institutional API requires the use of the Institutional Claims API for submission of claims to the payer; or, if you have another workflow for claims submissions, you may use that instead.
See the API Examples section on the left panel in the developer portal.
Please see example in Submit Edited Claims.
Please see example in Integrated Rules Institutional Submission and Response.
No, it does not. When you finish evaluating and correcting your claim through the Integrated Rules Institutional API, you can submit your corrected claim through the standard Institutional Claims API
institutionalclaims/v1/submission endpoint or through your accustomed workflow for that task.
The Integrated Rules Institutional API is designed as a complementary product for use with the Institutional Claims API.
If you use a different claim submission workflow, you can also submit your claim that way. Consult your Optum representative for more information.
Rates of unique claims are isolated to each individual provider. Every provider is different. Whenever you render a medical service, file a claim.
The Institutional Claims API FAQs topic discusses about many informative items that describe the various features and reasons to use the Institutional Claims API.
Please see example in X12 EDI 270 Request & 271 Response.
When your EDI formatted request is corrected and validated, use your normal claim submission workflow to submit the claim. The Institutional Claims v1 API does not directly support the X12 EDI submissions.
Updated 1 day ago