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View all our available APIs along with the specific details about each in the following dropdowns.

Learn more about Application Programming Interface (API).

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Claims API is an easy way to send and retrieve up-to-date claims information using automation capabilities. Reduce your organization’s development and support costs by integrating our claims services directly into your current workflows. API data can be distributed from and to practice management systems, hospital information systems, electronical medical records (EMRs), electronic health records (EHRs) and other applications your organization may use.

This is a Representational State Transfer (REST) API that includes:

Claim Reconsiderations and Appeals

  • Reconsideration submissions with attachments
  • Appeal submissions with attachments
  • Submission status

Claim Status and Payment

  • Claim summary information
  • Detailed claim data
  • Claim evaluation for payment and benefits/adjudication
  • Coordination of benefits detail
  • Claim payment information

Claim Submission API

  • Submit claims in EDI 837 X12 format
  • Institutional and Professional claims are accepted
  • Receive the 277CA claim acknowledgment status

Documents API

  • Pre-service documents
  • Claim and payment documents
  • 835 files in X12 format

The API uses JavaScript Object Notation (JSON) for requests and responses. All API traffic is encrypted over HTTPS and authentication is handled with OAuth 2.0.

Prerequisites

Registration and approval is required in the API Marketplace to obtain credentials to access API services.

Security

Claim Services APIs are secured using OAuth 2.0. All calls to APIs are encrypted over HTTPS. APIs support connections using TLS version 1.2 or higher. All modern languages and frameworks support TLS 1.2 (although specific older ones do not).

The Eligibility Basic Services API returns eligibility, benefit and copay information in real time. It also retrieves additional plan and member information including, but not limited to:

  • Primary care provider (PCP) details
  • Plan coverage
  • Benefit details
  • Member ID card
 

This is a Representational State Transfer (REST) API that returns:

  • Eligibility and benefits information for a member
  • Member copay information for a base set of services
  • Member copay information for specified services
  • Language preference
  • Member ID card
  • Network status
  • PCP details
  • Employer history
  • Preferred Lab Network
  • Service/benefit coordinator
  • Therapy services (occupational, physical, immunization)
  • Vision services
 

The API uses JavaScript Object Notation (JSON) for requests and responses. All API traffic is encrypted over HTTPS and authentication is handled with OAuth 2.0.

Prerequisites

Registration and approval is required in the API Marketplace to obtain credentials to access API services.

Security

Claim Services APIs are secured using OAuth 2.0. All calls to APIs are encrypted over HTTPS. APIs support connections using TLS version 1.2 or higher. All modern languages and frameworks support TLS 1.2 (although specific older ones do not).

The Eligibility Lightweight Services API provides basic eligibility and member information by member demographics.

This is a Representational State Transfer (REST) API that returns:

  • Basic eligibility information including demographics
  • Coverage attributes
  • Basic member information

The API uses JavaScript Object Notation (JSON) for requests and responses. All API traffic is encrypted over HTTPS and authentication is handled with OAuth 2.0.
 

Prerequisites

Registration and approval is required in the API Marketplace to obtain credentials to access API services.
 

Security

APIs are secured using OAuth 2.0. All calls to APIs are encrypted over HTTPS. APIs support connections using TLS version 1.2 or higher. All modern languages and frameworks support TLS 1.2 (although specific older ones do not).

Updating your information with insurance companies can be challenging. We've simplified it with our Provider Demographic Update API and Provider Roster API. Now, you can directly submit updates from your practice management systems to UnitedHealthcare, eliminating the need for emails, faxes, calls or portals. Our standardized and integrated approach helps ensure smooth communication between providers and UnitedHealthcare, making updates hassle-free.

The Provider Demographic Update API lets you manage provider details using National Provider Identifier (NPI) number, tax ID number (TIN) and Group information.

Operations include adding, updating or terminating provider data.


To request access, submit a JSON with details like:

  • Provider's name
  • Birth date
  • Gender
  • Medicaid/Medicare
  • Social Security Number
  • Degree
  • Cultural competency
  • Licenses (DEA, CDS)
  • Hospital affiliation

Prerequisites

Registration and approval is required in the API Marketplace to obtain credentials to access API services.

Security

APIs are secured using OAuth 2.0. All calls to APIs are encrypted over HTTPS. APIs support connections using TLS version 1.2 or higher. All modern languages and frameworks support TLS 1.2 (although specific older ones do not).

The Referrals API offers referral information.
 
This is a Referrals API that provides detailed information about previous referrals and referral submissions. The API uses JavaScript Object Notation (JSON) for requests and responses. All API traffic is encrypted over HTTPS and authentication is handled with OAuth 2.0.

Prerequisites

Registration and approval is required in the API Marketplace to obtain credentials to access API services.

Security

APIs are secured using OAuth 2.0. All calls to APIs are encrypted over HTTPS. APIs support connections using TLS version 1.2 or higher. All modern languages and frameworks support TLS 1.2 (although specific older ones do not).