openapi: 3.2.0
info:
  title: Optum Inquiry API
  version: '1.0'
  description: 'Operations tagged Inquiry across 2 of this provider''s published API definitions: optum-prior-authorization-v1-openapi.yml, optum-real-prior-authorization-api-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/
- url: /processor
- url: https://sandbox-apigw.optum.com
tags:
- name: Inquiry
paths:
  /inquiry/x12:
    post:
      summary: 278x215 Prior Authorization Inquiry
      description: 'Given a valid X12 278x215 request, the request will be submitted to the payer or clearing house and a 278 response returned.

        '
      tags:
      - Inquiry
      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/InquiryX12Request'
      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/InquiryResponse'
              examples:
                subscriber:
                  $ref: '#/components/examples/UserInquiryResponseSubscriber'
                dependent:
                  $ref: '#/components/examples/UserInquiryResponseDependent'
        '400':
          $ref: '#/components/responses/400'
        '401':
          $ref: '#/components/responses/401'
        '403':
          $ref: '#/components/responses/403'
        '500':
          $ref: '#/components/responses/500'
      security:
      - bearerAuth: []
    servers:
    - url: https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/
    - url: /processor
  /inquiry:
    post:
      summary: JSON Prior Authorization Inquiry
      description: 'Given a valid JSON request, the request will be submitted to the payer or clearing house and a JSON response returned.

        '
      tags:
      - Inquiry
      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/InquiryJSONRequest'
            examples:
              subscriber:
                $ref: '#/components/examples/UserInquiryRequestSubscriber'
              dependent:
                $ref: '#/components/examples/UserInquiryRequestDependent'
      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/InquiryResponse'
              examples:
                subscriber:
                  $ref: '#/components/examples/UserInquiryResponseSubscriber'
                dependent:
                  $ref: '#/components/examples/UserInquiryResponseDependent'
        '400':
          $ref: '#/components/responses/400'
        '401':
          $ref: '#/components/responses/401'
        '403':
          $ref: '#/components/responses/403'
        '500':
          $ref: '#/components/responses/500'
      security:
      - bearerAuth: []
    servers:
    - url: https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/
    - url: /processor
  /oihub/fhirpriorauth/v1/fhirpa/R4/{payerId}/{lob}/Claim/$inquire:
    post:
      operationId: inquireClaim
      tags:
      - Inquiry
      security:
      - oAuth:
        - read_healthcheck
      parameters:
      - name: payerId
        in: path
        required: true
        schema:
          type: string
          example: '87726'
      - name: lob
        in: path
        required: true
        schema:
          type: string
          example: bh
      - name: x-optum-consumer-correlation-id
        in: header
        schema:
          type: string
          description: Unique transaction identifier
          example: uuid-123
      - name: environment
        in: header
        schema:
          type: string
          description: Environment
          example: sandbox
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/InquireRequest'
            example:
              resourceType: Bundle
              id: pas-inquiry-request-bundle-example
              type: collection
              entry:
              - resource:
                  resourceType: Claim
                  id: claim-inquiry-example
                  contained:
                  - resourceType: Organization
                    id: requestor-organization-tin
                    identifier:
                    - system: http://hl7.org/fhir/sid/us-tin
                      value: '123456789'
                    name: Requestor Organization
                  - resourceType: Practitioner
                    id: facilityName
                    name:
                    - family: Medical Center
                  - resourceType: PractitionerRole
                    id: primary-role
                    practitioner:
                      reference: '#facilityName'
                  identifier:
                  - system: http://example.org/claim-ids
                    value: A123456789
                  meta:
                    profile:
                    - http://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition/profile-claim-inquiry
                  status: active
                  type:
                    coding:
                    - system: http://terminology.hl7.org/CodeSystem/claim-type
                      code: professional
                      display: Professional
                  patient:
                    reference: '#example'
                  use: preauthorization
                  created: '2023-10-05T08:30:00Z'
                  provider:
                    reference: '#requestor-organization-tin'
                    display: Requestor Organization
                  careTeam:
                  - provider:
                      reference: '#primary-role'
                    responsible: true
      responses:
        '200':
          description: Successful response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/InquireResponse'
              example:
                resourceType: Bundle
                entry:
                - resource:
                    resourceType: ClaimResponse
                    meta:
                      profile:
                      - https://hl7.org/fhir/us/davinci-pas/StructureDefinition-profile-claiminquiryresponse.html
                      tag:
                      - system: http://optum.com/fhir/wm/system/2021/07/resourceid
                        code: 8uj6vtuJ72g6wzEt46kqwjD+zY91vjtc3xBp0QTV0ZQd7vqimNYhpHtwnWeWUqLexvrvEVO+4rgK80Os00k+jrPw=
                      - system: COLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGING_SYSTEM_NAME
                        code: CollectionBasedFhirMethods(mostlikely@Search)shouldbepaged.PleaseelevatethisissuetoyourBAifyouareseeingthismessage.
                        display: XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.XXXCOLLECTION_BASED_FHIR_METHODS_SHOULD_IMPLEMENT_PAGINGXXX.
                    contained:
                    - resourceType: Patient
                      id: patientClaimReference
                      language: English
                      identifier:
                      - system: https://www.uhc.com/member-resources/your-member-id-card
                        value: '#memberId'
                      name:
                      - text: memberfullname
                        family: memberlastname
                        given:
                        - memberfirstname
                      telecom:
                      - system: phone
                        value: '#memberphone'
                      gender: membergender
                      communication:
                      - language:
                          coding:
                          - display: English
                      generalPractitioner:
                      - reference: '#practitionerReference'
                    - resourceType: Practitioner
                      id: practitionerReference
                      name:
                      - text: '#Practitioner'
                    - resourceType: Organization
                      id: organizationInsurerReference
                      meta:
                        profile:
                        - https://hl7.org/fhir/us/davinci-pas/STU2/StructureDefinition-profile-insurer
                      active: true
                      type:
                      - coding:
                        - system: https://hl7.org/fhir/R4/codesystem-organization-type.html#organization-type-pay
                          code: payer
                          display: Payer
                        text: Ahealthcarepayer.
                      name: UnitedHealthcare
                    - resourceType: Organization
                      id: organizationRequestorReference
                      identifier:
                      - system: https://hl7.org/fhir/sid/us-tin
                        value: '123456789'
                      active: true
                      name: MEDICALCENTER
                      telecom:
                      - system: phone
                        value: 123-456-7890
                      address:
                      - line:
                        - address1
                        city: address2
                        state: AZ
                        postalCode: postalcode
                      contact:
                      - telecom:
                        - system: phone
                          value: 123-456-7890
                        address:
                          text: address
                    identifier:
                    - system: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-identifier
                      value: A123456789
                    status: active
                    type:
                      coding:
                      - system: https://hl7.org/fhir/R4/valueset-claim-type.html
                        code: professional
                    use: preauthorization
                    patient:
                      reference: '#patientClaimReference'
                    created: '2025-09-26T09:39:48.115+00:00'
                    insurer:
                      reference: '#organizationInsurerReference'
                    requestor:
                      reference: '#organizationRequestorReference'
                    outcome: complete
                    disposition: Open
                    preAuthPeriod:
                      start: '2025-04-11'
                      end: '2025-07-10'
                    item:
                    - extension:
                      - url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber
                        valueIdentifier:
                          value: A123456789
                      - url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate
                        valueDate: '2025-04-11T06:48:28.407+00:00'
                      - url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod
                        valuePeriod:
                          start: '2025-04-11'
                          end: '2025-07-10'
                      itemSequence: 1
                      adjudication:
                      - extension:
                        - url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode
                          valueCodeableConcept:
                            coding:
                            - code: complete
                        category:
                          coding:
                          - system: http://terminology.hl7.org/CodeSystem/adjudication
                            code: submitted
                        reason:
                          coding:
                          - code: Covered/Approved
                  search:
                    mode: match
        '400':
          description: Bad Request
          content:
            application/json:
              example:
                message: Bad Request
                statusCode: 400
        '401':
          description: UnAuthorized
          content:
            application/json:
              example:
                message: UnAuthorized
                statusCode: 401
        '406':
          description: Not Acceptable
          content:
            application/json:
              example:
                message: Not Acceptable
                statusCode: 406
        '500':
          description: Internal Server Error
          content:
            application/json:
              example:
                message: Internal server error
                statusCode: 500
    servers:
    - url: https://sandbox-apigw.optum.com
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:
    UserInquiryResponseSubscriber:
      summary: Inquiry Response Subscriber Only
      value:
        authorizationId: a14081f3-b463-449e-a9dc-7ee21aef4552
        inquiry:
          x12: ISA*00*          *00*          *ZZ*INQMEDSOLUTIONS*ZZ*123456789      *240220*2059*^*00501*709893603*0*P*:~GS*HI*INQMEDSOLUTIONS*123456789*20240220*205925*148363198*X*005010X215~ST*278*0001*005010X215~BHT*0007*49*1234567890*20240220*205925*RD~HL*1**20*1~NM1*PR*2*MEDSOLUTIONS*****PI*CIGNA~PER*IC**UR*https//www.evicore.com/provider#login~HL*2*1*21*1~NM1*1P*2*WESTCHESTER MEDICAL CENTER*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*SMITH*TOM****MI* U1234567890~REF*SY*123121234~REF*3L*12345-1702~REF*1L*CIGNA SI-PPO/OAP~N3*SOME ROAD~N4*BEDFORD*NY*12345~DMG*D8*19700101~HL*4*3*EV*1~HCR*A1*A12345678~REF*BB*A12345678~REF*NT*52598960~DTP*102*D8*20240220~DTP*036*D8*20240818~DTP*007*D8*20240220~DTP*881*D8*20240220~HI*ABK:R07.9~MSG*APPROVED~NM1*FA*2*TEST, DOMINICA*****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*2223334444*FX*1112223333~NM1*DN*1*TEST*DOMINICA****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*3334445555~HL*5*4*SS*0~HCR*A1*A12345678~SV1*HC:78452**UN*1~MSG*MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES~SE*39*0001~GE*1*148363198~IEA*1*709893603~
          json:
            submitterTransactionIdentifier: '1234567890'
            payerId: CIGNA
            payerName: MEDSOLUTIONS
            umClearingHouseId: '123456789'
            contactUrl: https//www.evicore.com/provider#login
            umRequestValidation: null
            requester:
              requesterType: 1P
              organizationName: WESTCHESTER MEDICAL CENTER
              requesterIdentification:
                employerIdentificationNumber: '123456789'
              npi: '1234567890'
            subscriber:
              lastName: SMITH
              firstName: TOM
              memberId: ' U1234567890'
              dateOfBirth: '19700101'
              address1: SOME ROAD
              city: BEDFORD
              state: NY
              postalCode: '12345'
              supplementalIdentification:
                policyNumber: CIGNA SI-PPO/OAP
                branchIdentifier: 12345-1702
                ssn: '123121234'
            patientEventDetail:
              certificationActionCode: A1
              reviewIdentificationNumber: A12345678
              previousReviewAuthorizationNumber: A12345678
              previousAdministrativeReferenceNumber: '52598960'
              certificationIssueDate: '20240220'
              certificationExpirationDate: '20240818'
              certificationEffectiveDateBegin: '20240220'
              healthCareServicesReviewRequestDateBegin: '20240220'
              diagnosisTypeCode: ABK
              diagnosisCode: R07.9
              freeFormMessageText: APPROVED
              patientEventProviderName:
              - entityIdentifierCode: FA
                organizationName: TEST, DOMINICA
                identificationCodeQualifier: XX
                identifier: '1234567890'
                address1: 100 DEMO RD
                city: VALHALLA
                state: NY
                postalCode: '12345'
                providerSupplementalInformation: {}
                contactFacsimile: '1112223333'
                contactTelephone: '2223334444'
              - entityIdentifierCode: DN
                lastName: TEST
                firstName: DOMINICA
                identificationCodeQualifier: XX
                identifier: '1234567890'
                address1: 100 DEMO RD
                city: VALHALLA
                state: NY
                postalCode: '12345'
                providerSupplementalInformation: {}
                contactTelephone: '3334445555'
              serviceLevel:
              - certificationActionCode: A1
                reviewIdentificationNumber: A12345678
                professionalService:
                  productOrServiceIDQualifier: HC
                  procedureCode: '78452'
                  unitOrBasisForMeasurementCode: UN
                  serviceUnitCount: '1'
                institutionalService: {}
                dentalService: {}
                freeFormMessageText: MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES
    UserInquiryRequestSubscriber:
      summary: Inquiry Request Subscriber Only
      value:
        senderId: 201985AAS
        submitterTransactionIdentifier: '1234567890'
        payerId: BCBSSC
        payerName: South Carolina Blue Cross Blue
        umClearingHouseId: '000000000000001'
        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: ZCS12345678
          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: '71260'
          - requestCategoryCode: HS
            facilityTypeCode: '11'
            facilityCodeQualifier: B
            serviceDateBegin: '20231017'
            serviceDateEnd: '20231017'
            professionalService:
              productOrServiceIDQualifier: HC
              procedureCode: '74177'
    UserInquiryRequestDependent:
      summary: Inquiry Request with Dependent
      value:
        senderId: 201985AAS
        submitterTransactionIdentifier: '1234567890'
        payerId: BCBSSC
        payerName: South Carolina Blue Cross Blue
        umClearingHouseId: '000000000000001'
        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: ZCS12345678
          dateOfBirth: '19701231'
          supplementalIdentification:
            groupNumber: '123456789'
            ssn: '111223333'
        dependent:
          lastName: TEST
          firstName: MARY
          dateOfBirth: '201001231'
          supplementalIdentification:
            ssn: '444556666'
        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: '71260'
          - requestCategoryCode: HS
            facilityTypeCode: '11'
            facilityCodeQualifier: B
            serviceDateBegin: '20231017'
            serviceDateEnd: '20231017'
            professionalService:
              productOrServiceIDQualifier: HC
              procedureCode: '74177'
    UserInquiryResponseDependent:
      summary: Inquiry Response with Dependent
      value:
        authorizationId: a14081f3-b463-449e-a9dc-7ee21aef4552
        inquiry:
          x12: ISA*00*          *00*          *ZZ*INQMEDSOLUTIONS*ZZ*123456789      *240220*2059*^*00501*709893603*0*P*:~GS*HI*INQMEDSOLUTIONS*123456789*20240220*205925*148363198*X*005010X215~ST*278*0001*005010X215~BHT*0007*49*1234567890*20240220*205925*RD~HL*1**20*1~NM1*PR*2*MEDSOLUTIONS*****PI*CIGNA~PER*IC**UR*https//www.evicore.com/provider#login~HL*2*1*21*1~NM1*1P*2*WESTCHESTER MEDICAL CENTER*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*SMITH*TOM****MI* U1234567890~REF*SY*123121234~REF*3L*12345-1702~REF*1L*CIGNA SI-PPO/OAP~N3*SOME ROAD~N4*BEDFORD*NY*12345~DMG*D8*19700101~HL*4*3*EV*1~HCR*A1*A12345678~REF*BB*A12345678~REF*NT*52598960~DTP*102*D8*20240220~DTP*036*D8*20240818~DTP*007*D8*20240220~DTP*881*D8*20240220~HI*ABK:R07.9~MSG*APPROVED~NM1*FA*2*TEST, DOMINICA*****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*2223334444*FX*1112223333~NM1*DN*1*TEST*DOMINICA****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*3334445555~HL*5*4*SS*0~HCR*A1*A12345678~SV1*HC:78452**UN*1~MSG*MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES~SE*39*0001~GE*1*148363198~IEA*1*709893603~
          json:
            submitterTransactionIdentifier: '1234567890'
            payerId: CIGNA
            payerName: MEDSOLUTIONS
            umClearingHouseId: '123456789'
            contactUrl: https//www.evicore.com/provider#login
            umRequestValidation: null
            requester:
              requesterType: 1P
              organizationName: WESTCHESTER MEDICAL CENTER
              requesterIdentification:
                employerIdentificationNumber: '123456789'
              npi: '1234567890'
            subscriber:
              lastName: SMITH
              firstName: TOM
              memberId: ' U1234567890'
              dateOfBirth: '19700101'
              address1: SOME ROAD
              city: BEDFORD
              state: NY
              postalCode: '12345'
              supplementalIdentification:
                policyNumber: CIGNA SI-PPO/OAP
                branchIdentifier: 12345-1702
                ssn: '123121234'
            dependent:
              lastName: SMITH
              firstName: JANE
              dateOfBirth: '19700101'
              address1: SOME ROAD
              city: BEDFORD
              state: NY
              postalCode: '12345'
              supplementalIdentification:
                ssn: '123984321'
            patientEventDetail:
              certificationActionCode: A1
              reviewIdentificationNumber: A12345678
              previousReviewAuthorizationNumber: A12345678
              previousAdministrativeReferenceNumber: '52598960'
              certificationIssueDate: '20240220'
              certificationExpirationDate: '20240818'
              certificationEffectiveDateBegin: '20240220'
              healthCareServicesReviewRequestDateBegin: '20240220'
              diagnosisTypeCode: ABK
              diagnosisCode: R07.9
              freeFormMessageText: APPROVED
              patientEventProviderName:
              - entityIdentifierCode: FA
                organizationName: TEST, DOMINICA
                identificationCodeQualifier: XX
                identifier: '1234567890'
                address1: 100 DEMO RD
                city: VALHALLA
                state: NY
                postalCode: '12345'
                providerSupplementalInformation: {}
                contactFacsimile: '1112223333'
                contactTelephone: '2223334444'
              - entityIdentifierCode: DN
                lastName: TEST
                firstName: DOMINICA
                identificationCodeQualifier: XX
                identifier: '1234567890'
                address1: 100 DEMO RD
                city: VALHALLA
                state: NY
                postalCode: '12345'
                providerSupplementalInformation: {}
                contactTelephone: '3334445555'
              serviceLevel:
              - certificationActionCode: A1
                reviewIdentificationNumber: A12345678
                professionalService:
                  productOrServiceIDQualifier: HC
                  procedureCode: '78452'
                  unitOrBasisForMeasurementCode: UN
                  serviceUnitCount: '1'
                institutionalService: {}
                dentalService: {}
                freeFormMessageText: MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES
  schemas:
    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
    InquiryX12Request:
      type: object
      properties:
        x12:
          type: string
          description: EDI X12 278x215 Request
          example: ISA*00*          *00*          *ZZ*943207296      *ZZ*000000000000001*230810*1021*^*00501*916040697*0*P*:~GS*HI*943207296*INQHEALTHHELP*20230810*102137*3294199*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1402448037*20230810*102137~HL*1**20*1~NM1*PR*2*Humana*****PI*HUMANA~HL*2*1*21*1~NM1*1P*2*North Memorial Health*****XX*1851344907~REF*EI*410729979~N4*Robbinsdale*MN*55422~PER*IC**TE*7635814480*FX*7635814480~HL*3*2*22*1~NM1*IL*1*DOE*JOE****MI*H1111111~REF*6P*00000000~DMG*D8*19010101~HL*4*3*EV*0~UM*HS*I*1*11:B~DTP*AAH*D8*20230802~HI*ABK:C34.32~NM1*SJ*2*North Memorial Medical Center*****XX*1851344907~NM1*DN*2*North Memorial Medical Center*****XX*1851344907~REF*ZH*410729979~SE*21*0001~GE*1*3294199~IEA*1*916040697~
    InquiryResponse:
      type: object
      properties:
        authorizationId:
          type: string
        inquiry:
          type: object
          properties:
            x12:
              type: string
            json:
              $ref: '#/components/schemas/AuthorizationJSONResponse'
    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'
    Entry:
      type: object
      properties:
        resource:
          $ref: '#/components/schemas/Claim'
    CareTeam:
      type: object
      properties:
        provider:
          $ref: '#/components/schemas/Reference'
        responsible:
          type: boolean
          example: true
    ResponseEntry:
      type: object
      properties:
        resource:
          $ref: '#/components/schemas/ClaimResponse'
        search:
          type: object
          properties:
            mode:
              type: string
              example: match
    ClaimResponse:
      type: object
      description: FHIR ClaimResponse
      properties:
        resourceType:
          type: string
          example: ClaimResponse
        meta:
          $ref: '#/components/schemas/Meta'
        identifier:
          type: array
          items:
            $ref: '#/components/schemas/Identifier'
        status:
          type: string
          example: active
        type:
          $ref: '#/components/schemas/CodeableConcept'
        use:
          type: string
          example: preauthorization
        created:
          type: string
          example: '2025-09-26T09:39:48+00:00'
        patient:
          $ref: '#/components/schemas/Reference'
        insurer:
          $ref: '#/components/schemas/Reference'
        requestor:
          $ref: '#/components/schemas/Reference'
        outcome:
          type: string
          example: complete
        disposition:
          type: string
          example: Open
        preAuthPeriod:
          $ref: '#/components/schemas/Period'
        item:
          type: array
          items:
            $ref: '#/components/schemas/ResponseItem'
    CodeableConcept:
      type: object
      description: FHIR CodeableConcept
      properties:
        coding:
          type: array
          items:
            $ref: '#/components/schemas/Coding'
    ResponseItem:
      type: object
      properties:
        itemSequence:
          type: integer
          example: 1
        extension:
          type: array
          items:
            $ref: '#/components/schemas/Extension'
        adjudication:
          type: array
          items:
            $ref: '#/components/schemas/Adjudication'
    Meta:
      type: object
      description: FHIR metadata
      properties:
        profile:
          type: array
          description: FHIR profile URLs
          items:
            type: string
            example: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse-adapt
    Extension:
      type: object
      description: FHIR extension with Reference
      properties:
        url:
          type: string
          example: http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context
        valueReference:
          $ref: '#/components/schemas/Reference'
    Adjudication:
      type: object
      properties:
        category:
          $ref: '#/components/schemas/CodeableConcept'
        reason:
          $ref: '#/components/schemas/CodeableConcept'
        extension:
          type: array
          items:
            $ref: '#/components/schemas/Extension'
    Identifier:
      type: object
      properties:
        system:
          type: string
          example: http://example.org/cdex/acn
        value:
          type: string
          example: '123456'
    Period:
      type: object
      properties:
        start:
          type: string
          example: '2025-04-11'
        end:
          type: string
          example: '2025-07-10'
    Claim:
      type: object
      description: FHIR Claim Inquiry Request
      properties:
        resourceType:
          type: string
          example: Claim
        id:
          type: string
        meta:
          $ref: '#/components/schemas/Meta'
        identifier:
          type: array
          items:
            $ref: '#/components/schemas/Identifier'
        status:
          type: string
          example: active
        type:
          $ref: '#/components/schemas/CodeableConcept'
        use:
          type: string
          example: preauthorization
        created:
          type: string
          example: '2023-10-05T08:30:00Z'
        patient:
          $ref: '#/components/schemas/Reference'
        provider:
          $ref: '#/components/schemas/Reference'
        careTeam:
          type: array
          items:
            $ref: '#/components/schemas/CareTeam'
    Coding:
      type: object
      description: Coding structure for answers
      properties:
        code:
          type: string
          example: '1'
        display:
          type: string
          example: Age ≥ 50
    Reference:
      type: object
      description: FHIR Reference
      properties:
        reference:
          type: string
          example: Patient/anonymous
    InquireRequest:
      type: object
      description: FHIR Bundle for claim inquiry
      properties:
        resourceType:
          type: string
          example: Bundle
        id:
          type: string
          example: pas-inquiry-request-bundle-example
        type:
          type: string
          example: collection
        entry:
          type: array
          items:
            $ref: '#/components/schemas/Entry'
    InquireResponse:
      type: object
      description: FHIR Bundle with ClaimResponse
      properties:
        resourceType:
          type: string
          example: Bundle
        entry:
          type: array
          items:
            $ref: '#/components/schemas/ResponseEntry'
  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
    oAuth:
      type: oauth2
      description: This API uses OAuth 2 with the client_credentials grant flow.
      flows:
        clientCredentials:
          tokenUrl: /apip/auth/v2/token
          scopes:
            read_txn: read transactions
            create_txn: submit a new transaction request
            read_coveragediscovery: read coverage discovery tasks
            create_coveragediscovery: submit a new coverage discovery task
            read_healthcheck: check the status of the system
x-refined-from:
- optum-prior-authorization-v1-openapi.yml
- optum-real-prior-authorization-api-openapi.yml
x-readme:
  explorer-enabled: true
  proxy-enabled: true