openapi: 3.0.0 info: version: 1.0.0 description: API for RTS Payer Dental Claim Actions title: Real Dental Claim Submission API servers: - url: https://sandbox-apigw.optum.com paths: /py/oihub/claim/dnt/submit/v1/graphql: post: parameters: - name: providerTaxId in: header description: Provider Tax ID required: false schema: type: string example: '123456789' - name: x-optum-consumer-correlation-id in: header description: 'Correlation ID can be used to trigger the Mock API call for dental claim submission. Use "test_" in order to hit the Mock flow. Example correlation ID : test_dnt-claim-submission-200_success' required: false schema: type: string example: 4d4a8964-e5fa-42dc-a37d-12345789 requestBody: content: application/json: schema: description: GraphQL request with query and variables for Dental Claim Submission type: object required: - query - variables properties: query: type: string description: GraphQL mutation query string example: 'mutation claimActions($input: ClaimSubmissionInput!) { claimSubmission(input: $input) { transactionId x12Response277CA message statusCode } }' variables: type: object description: Variables for the GraphQL query required: - input properties: input: description: Claim submission input data $ref: '#/components/schemas/ClaimSubmissionInput' examples: SubmitDentalClaim: summary: Submit Dental Claim Request value: query: 'mutation claimActions($input: ClaimSubmissionInput!) { claimSubmission(input: $input) { transactionId x12Response277CA message statusCode } }' variables: input: x12RequestData: ISA*00* *00* *ZZ*DENTAL123 *ZZ*PAYER456 *260113*1430*^*00501*000000001*0*P*:~GS*HC*DENTAL123*PAYER456*20260113*1430*1*X*005010X224A2~ST*837*0001*005010X224A2~BHT*0019*00*D001*20260113*1430*CH~NM1*41*2*ABC DENTAL*****XX*1234567890~PER*IC*CONTACT*TE*5551234567~NM1*40*2*DELTA DENTAL*****46*98765~HL*1**20*1~PRV*BI*PXC*1223G0001X~NM1*85*2*ABC DENTAL*****XX*1234567890~N3*555 DENTAL DR~N4*CITY*ST*12345~REF*EI*123456789~HL*2*1*22*0~SBR*P*18*******CI~NM1*IL*1*SMITH*JANE****MI*ABC123456~N3*456 ELM ST~N4*CITY*ST*12345~DMG*D8*19800101*F~NM1*PR*2*DELTA DENTAL*****PI*98765~CLM*D001*150***11:B:1*Y*A*Y*Y~DTP*431*D8*20260110~REF*D9*REF789~HI*ABK:K0210~LX*1~SV3*AD:D0120*150**1~TOO*JP*4~DTP*472*D8*20260110~SE*23*0001~GE*1*1~IEA*1*000000001~ payerId: '88848' required: true tags: - Dental Claim Actions responses: '200': content: application/json: examples: SubmitDentalClaim: summary: Dental Claim Submission Response value: transactionId: '8841512345678901' x12Response277CA: ISA*00* *00* *ZZ*87726 *ZZ*B00099999805 *250911*1927*^*00501*000000000*0*P*:~GS....~GE*1*0~IEA*1*000000000~ message: Claim submitted successfully. Refer 277CA for validation outcomes. statusCode: '000' schema: type: object properties: data: type: object properties: claimSubmissionResponse: description: '' $ref: '#/components/schemas/ClaimSubmissionResponse' errors: items: type: object properties: code: type: string description: Error code identifying the specific error description: type: string description: Detailed error message description: List of errors that occurred during Dental Claim Actions type: array description: '**SubmitDentalClaim** **Success Response:** * 000 - Dental claim submitted successfully. Refer 277CA for validation outcomes. **Error Codes (Global Codes):** * REQ_401 - Unauthorized: Missing/invalid/expired credentials or token * REQ_422 - Validation failed: Request is syntactically valid but fails semantic validation * REQ_500 - Internal server error: Unexpected error * REQ_503 - Service unavailable: Downstream service is currently unavailable * REQ_504 - Gateway timeout: Upstream dependency timed out * GTW_06 - TA1 Rejection: TA1 acknowledgment indicates envelope failure * GTW_08 - Unknown Document: Gateway does not recognize document structure * GTW_11 - Service Failure: General processing error at the downstream service * GTW_12 - Downstream Timeout: Payer system failed to respond within SLA * GTW_13 - Persistence Error: Internal storage failure at the gateway * GTW_14 - Ack Failure: Failure generating downstream 999/277 files * GTW_15 - Config Error: Downstream environment configuration mismatch * EDI_200 - Wrong Claim Type: Expected 837D (Dental) * EDI_203 - Batch Not Allowed: Multiple ST-SE segments detected. Single-claim submissions only * EDI_206 - Invalid segment: One or more segments are invalid, out of order, or not allowed ' '401': content: application/json: example: statusCode: 401 message: Unauthorized description: Unauthorized '500': content: application/json: example: statusCode: 500 message: Internal server error description: Internal Server Error description: 'The Dental Claim Action API facilitates dental claim submission in X12 format and returns responses in the 277CA format. It provides a flexible GraphQL endpoint to streamline end-to-end dental claim action processing. Below operation is supported: SubmitDentalClaim: Validates if the dental claim submitted is eligible for claim submission and upon validation if the claim is eligible for submission, claim will be submitted.' summary: Dental Claim Actions API operationId: dntClaimActions security: - bearerAuth: [] /py/oihub/claim/dnt/submit/v1/health-check: get: responses: '200': description: Service is healthy '500': description: Service is unhealthy operationId: healthCheck tags: - HealthCheck summary: Health Check Endpoint security: - bearerAuth: [] components: schemas: ClaimSubmissionInput: type: object description: ClaimSubmissionInput properties: x12RequestData: example: ISA*00* *00* *ZZ*SENDER ID *ZZ*RECEIVER ID *231012*1200*U*00501*000000001*0*P*:~ GS*HP*SENDERAPP*RECEIVERAPP*20231012*1200*000000001*X*005010X222A1~ ST*837*0001*005010X222A1~ [... BHT, HL, PRV, N1, N3, N4, CLM, CAS, PLB, HI, DMG, and other 837 segments...] SE*32*0001~ GE*1*000000001~ IEA*1*000000001~ description: EDI837 X12 formatted claim data type: string payerId: example: '88848' description: payer ID type: string ClaimSubmissionResponse: type: object description: ClaimSubmissionResponse properties: transactionId: example: '8841512345678901' description: unique transactionID created by the payer for the claim submission request. type: string x12Response277CA: example: ISA*00* *00* *ZZ*87726 *ZZ*B00099999805 *250911*1927*^*00501*000000000*0*P*:~GS....~GE*1*0~IEA*1*000000000~ description: edi x12-277 claim acknowledgement. type: string message: example: Claim submitted successfully. Refer 277CA for validation outcomes. description: Message describing the final outcome of the claim submission process. type: string statusCode: example: '000' description: status code for the submission process. type: string securitySchemes: bearerAuth: type: http scheme: bearer bearerFormat: JWT description: Enter a Bearer access token. The API Explorer applies the Bearer scheme. security: - bearerAuth: [] x-readme: explorer-enabled: true proxy-enabled: true