openapi: 3.2.0 info: title: Prior Authorization v1 Authorization (Orchestration) API description: '' version: 1.1.0 contact: email: '' servers: - url: https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/ - url: /processor security: - bearerAuth: [] tags: - name: Authorization (Orchestration) paths: /authorization/x12: post: summary: 278x215 Prior Authorization Orchestration description: Prior authorization orchestration using EDI X12 278x215 requests tags: - Authorization (Orchestration) parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/AuthorizationX12Request' examples: required-and-not-required: $ref: '#/components/examples/X12OrchRequestTwoCodesOneRequired' required-with-split: $ref: '#/components/examples/X12OrchRequestTwoRequiredCodesWithSplit' no-procedure-codes: $ref: '#/components/examples/X12OrchRequestNoProcedureCodes' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/AuthorizationResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /authorization: post: summary: JSON Prior Authorization Orchestration description: Prior authorization orchestration using JSON requests tags: - Authorization (Orchestration) parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/InquiryJSONRequestWithDetermination' examples: inquiry-split: $ref: '#/components/examples/OrchestrationJSONRequestWithSplit' single-requires-pa: $ref: '#/components/examples/OrchestrationJSONRequestOneRequired' none-require-pa: $ref: '#/components/examples/OrchestrationJSONRequestAuthNotRequired' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/AuthorizationResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' components: headers: transaction-id: description: Transaction Id of the request required: true schema: type: string format: uuid example: c9476bc2-b563-4555-9527-4afe9dccaf9a x-amzn-trace-id: description: Generated traceId of the request required: true example: Root=1-61d7441a-56e4c77350687b5230e5707 schema: type: string examples: X12OrchRequestNoProcedureCodes: summary: X12 Orchestration - No procedure codes require auth value: rhPayerId: UHCDEMODV1 planId: '41' x12: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:6789T~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:9876T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ X12OrchRequestTwoRequiredCodesWithSplit: summary: X12 Orchestration - Two procedure codes require auth with split value: rhPayerId: UHCDEMODV1 planId: '41' x12: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:0214T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ X12OrchRequestTwoCodesOneRequired: summary: X12 Orchestration - Two procedure codes; one requires auth value: rhPayerId: UHCDEMODV1 planId: '41' x12: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:9876T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ OrchestrationJSONRequestAuthNotRequired: summary: JSON Orchestration - No procedure codes require auth value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: UHCDIRECT requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: multi-01-approved dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 6789T - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 9876T OrchestrationJSONRequestWithSplit: summary: JSON Orchestration - Two procedure codes require auth with split value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: UHCDIRECT requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: multi-01-approved dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: T1000 - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 0214T OrchestrationJSONRequestOneRequired: summary: JSON Orchestration - Two procedure codes; one requires auth value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: UHCDIRECT requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: multi-01-approved dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: T1000 - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 9876T schemas: InquiryJSONRequestWithDetermination: allOf: - $ref: '#/components/schemas/InquiryJSONRequest' - type: object properties: rhPayerId: type: string description: Global payer identifier used for determination example: UHCDEMODV1 planId: type: string description: Payer plan identifier used for determination example: '41' AuthorizationResponse: type: object properties: authorizationId: type: string determination: type: object properties: x12: type: string json: $ref: '#/components/schemas/AuthorizationJSONResponse' inquiry: type: array maxItems: 100 items: type: object properties: x12: type: string json: $ref: '#/components/schemas/AuthorizationJSONResponse' AuthorizationJSONResponse: type: object properties: requestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string contactUrl: type: string umRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requester: $ref: '#/components/schemas/AuthorizationJSONResponseRequester' subscriber: $ref: '#/components/schemas/AuthorizationJSONResponseSubscriber' dependent: $ref: '#/components/schemas/AuthorizationJSONResponseDependent' patientEventDetail: $ref: '#/components/schemas/AuthorizationJSONResponsePatientEventDetail' AuthorizationJSONResponsePatientEventDetail: type: object properties: dependentRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string healthCareServicesReviewRequestDateBegin: type: string healthCareServicesReviewRequestDateEnd: type: string diagnosisTypeCode: type: string diagnosisCode: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string institutionalAdmissionTypeCode: type: string institutionalAdmissionSourceCode: type: string institutionalPatientStatusCode: type: string ambulanceTransportCode: type: string ambulanceUnitOrBasisForMeasurementCode: type: string ambulanceTransportDistance: type: string spinalManipulationTreatmentSeriesNumber: type: string spinalManipulationTreatmentCount: type: string spinalManipulationSubluxationLevelCode: type: string spinalManipulationSubluxationLevelCode2: type: string oxygenEquipmentTypeCode: type: string oxygenEquipmentTypeCode2: type: string oxygenFlowRate: type: string dailyOxygenUseCount: type: string oxygenUsePeriodHourCount: type: string respiratoryTherapistOrderText: type: string portableOxygenSystemFlowRate: type: string oxygenDeliverySystemCode: type: string oxygenSystemTypeCode: type: string homeHealthPrognosisCode: type: string homeHealthStartDate: type: string homeHealthCertificationPeriod: type: string homeHealthMedicareCoverageIndicator: type: string homeHealthCertificationTypeCode: type: string freeFormMessageText: type: string patientEventProviderName: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponsePatientEventProviderName' patientEventTransportInformation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponsePatientEventTransportInformation' serviceLevel: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseServiceLevel' AuthorizationJSONResponsePatientEventTransportInformation: type: object properties: entityIdentifierCode: type: string organizationName: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string AuthorizationJSONResponseRequestValidation: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string AuthorizationJSONResponseIonalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string serviceLineRate: type: string epsdtIndicator: type: string AuthorizationJSONResponsePatientEventProviderName: type: object properties: patientEventProviderRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: $ref: '#/components/schemas/AuthorizationJSONResponseProviderSupplementalInformation' contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string contactUrl: type: string providerCode: type: string providerTaxonomyCode: type: string AuthorizationJSONResponseDependent: type: object properties: dependentRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string supplementalIdentification: $ref: '#/components/schemas/AuthorizationJSONResponseDependentSupplementalIdentification' InquiryJSONRequest: type: object properties: senderId: type: string submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string requester: type: object properties: requesterType: type: string organizationName: type: string lastName: type: string firstName: type: string requesterIdentification: type: object properties: providerUpinNumber: type: string facilityIdNumber: type: string employerIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdNumber: type: string facilityNetworkIdNumber: type: string socialSecurityNumber: type: string federalTaxpayerIdentificationNumber: type: string carrierAssignedReferenceNumber: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string npi: type: string payorId: type: string ssn: type: string servicesPlanID: type: string employersId: type: string etin: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string providerCode: type: string referenceIdentification: type: string subscriber: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string memberId: type: string dateOfBirth: type: string supplementalIdentification: type: object properties: policyNumber: type: string branchIdentifier: type: string groupNumber: type: string departmentNumber: type: string patientAccountNumber: type: string healthInsuranceClaimNumber: type: string idCard: type: string insurancePolicyNumber: type: string planNetworkIdentificationNumber: type: string medicaidRecipientIdentificationNumber: type: string ssn: type: string dependent: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string supplementalIdentification: type: object properties: employeeIdentificationNumber: type: string patientAccountNumber: type: string ssn: type: string patientEventDetail: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string accidentDate: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string certificationIssueDateBegin: type: string certificationIssueDateEnd: type: string certificationExpirationDateBegin: type: string certificationExpirationDateEnd: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string healthCareServicesReviewRequestDate: type: string diagnosisTypeCode: type: string diagnosisCode: type: string patientEventProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string providerCode: type: string providerTaxonomyCode: type: string serviceLevel: type: array items: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string certificationIssueDateBegin: type: string certificationIssueDateEnd: type: string certificationExpirationDateBegin: type: string certificationExpirationDateEnd: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string professionalService: type: object properties: productOrServiceIDQualifier: type: string procedureCode: type: string procedureCode2: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string institutionalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureCode2: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string dentalService: type: object properties: procedureCode: type: string procedureCode2: type: string americanDentalAssociationCodes: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string toothInformation: type: object properties: toothCode: type: string toothSurfaceCode: type: string serviceProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string providerCode: type: string providerTaxonomyCode: type: string AuthorizationJSONResponseDependentSupplementalIdentification: type: object additionalProperties: false properties: employeeIdentificationNumber: type: string patientAccountNumber: type: string ssn: type: string AuthorizationJSONResponseServiceLevel: type: object properties: serviceRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string professionalService: $ref: '#/components/schemas/AuthorizationJSONResponseIonalService' institutionalService: $ref: '#/components/schemas/AuthorizationJSONResponseIonalService' dentalService: $ref: '#/components/schemas/AuthorizationJSONResponseDentalService' toothInformation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseToothInformation' quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string freeFormMessageText: type: string serviceProviderName: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseServiceProviderName' AuthorizationJSONResponseRequesterIdentification: type: object properties: providerUpinNumber: type: string facilityIdNumber: type: string employerIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdNumber: type: string facilityNetworkIdNumber: type: string socialSecurityNumber: type: string carrierAssignedReferenceNumber: type: string AuthorizationJSONResponseRequester: type: object properties: requesterRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requesterType: type: string organizationName: type: string lastName: type: string firstName: type: string requesterIdentification: $ref: '#/components/schemas/AuthorizationJSONResponseRequesterIdentification' npi: type: string payorId: type: string ssn: type: string servicesPlanID: type: string employersId: type: string etin: type: string providerCode: type: string referenceIdentification: type: string AuthorizationJSONResponseProviderSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string providerSiteNumber: type: string AuthorizationJSONResponseDentalService: type: object properties: procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string americanDentalAssociationCodes: type: string americanDentalAssociationCodes2: type: string americanDentalAssociationCodes3: type: string americanDentalAssociationCodes4: type: string americanDentalAssociationCodes5: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string Errors: type: array items: type: string example: This is an example error string AuthorizationJSONResponseSubscriberSupplementalIdentification: type: object properties: policyNumber: type: string branchIdentifier: type: string groupNumber: type: string departmentNumber: type: string patientAccountNumber: type: string healthInsuranceClaimNumber: type: string idCard: type: string insurancePolicyNumber: type: string planNetworkIdentificationNumber: type: string medicaidRecipientIdentificationNumber: type: string ssn: type: string AuthorizationJSONResponseToothInformation: type: object properties: toothCode: type: string toothSurfaceCode: type: string toothSurfaceCode2: type: string toothSurfaceCode3: type: string toothSurfaceCode4: type: string toothSurfaceCode5: type: string AuthorizationJSONResponseServiceProviderName: type: object properties: serviceProviderRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: $ref: '#/components/schemas/AuthorizationJSONResponseProviderSupplementalInformation' contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string contactUrl: type: string providerCode: type: string providerTaxonomyCode: type: string AuthorizationJSONResponseSubscriber: type: object properties: subscriberRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' lastName: type: string firstName: type: string middleName: type: string suffix: type: string memberId: type: string dateOfBirth: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string supplementalIdentification: $ref: '#/components/schemas/AuthorizationJSONResponseSubscriberSupplementalIdentification' AuthorizationX12Request: type: object properties: rhPayerId: type: string description: Global payer identifier used for determination example: UHCDEMODV1 planId: type: string description: Payer plan identifier used for determination example: 41 x12: type: string description: EDI X12 278x215 Request example: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:0214T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ responses: '403': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Forbidden. Authentication succeeded but authenticated user doesn't have access to the resource content: application/json: schema: $ref: '#/components/schemas/Errors' '401': description: Unauthorized. No or invalid authentication details are provided headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' content: application/json: schema: $ref: '#/components/schemas/Errors' '400': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Bad Request. The request body is malformed or missing required information. content: application/json: schema: $ref: '#/components/schemas/Errors' '500': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Internal Server Error. An unexpected error has occurred. content: application/json: schema: $ref: '#/components/schemas/Errors' parameters: x-optum-tenant-id: description: The unique ID of the tenant that the invoking user belongs to. in: header name: x-optum-tenant-id schema: type: string format: uuid example: 9fb77454-8c58-4345-aa50-43f133e06d20 required: true x-optum-correlation-id: description: A unique identifier assigned to each request. in: header name: x-optum-correlation-id schema: type: string format: uuid example: c9476bc2-b563-4555-9527-4afe9dccaf9a securitySchemes: bearerAuth: type: http scheme: bearer bearerFormat: JWT