API Connectivity Options and Transaction Types

API uses a Representational State Transfer (REST) connection and returns in a JavaScript Object Notation (JSON) format. UnitedHealthcare offers 2 API options:

Link API

Connect to us directly through a secure connection for all available API transaction types. View the reference guides for specific data returned for each transaction type and current options available:

API Extended X12

API data is returned as an extension to your existing compliant EDI transaction responses. The extended data provides information that is not included in the standard EDI response, which eliminates billing staff having to call us or going to the UnitedHealthcare Provider Portal to look it up.

API Extended X12 is currently available for Claim Status and Eligibility and Benefits. To establish connectivity for API Extended X12, contact us directly for assistance or contact your clearinghouse to inquire about the UnitedHealthcare data they have available through their API services. View the implementation guides for extended data elements returned with EDI response transactions:

API Transaction 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 more detailed information.

Claim status

  • Status of claim
  • Amount and date paid
  • Payment number
  • Claim and line-level detail
  • Coordination of benefits (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)

Online communications (paperless)

  • Claim letters
  • Claim acknowledgment
  • 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

Need help?

If you need technical help, please email physicians_esolutions@uhc.com. For more on API Extended X12, email supportedi@uhc.com or call 800-842-1109.