aid: unitedhealth url: https://raw.githubusercontent.com/api-evangelist/unitedhealth/refs/heads/main/apis.yml name: UnitedHealth Group description: >- UnitedHealth Group is a diversified health care company with two distinct platforms, UnitedHealthcare for health benefits and Optum for health services, serving more than 100 million people worldwide. The company offers FHIR R4-compliant Interoperability APIs through the Optum platform, providing patient access to health records, claims history, provider directory, and drug formulary data in compliance with CMS Interoperability and Patient Access final rule (CMS-9115-F) and HL7 FHIR standards. tags: - Healthcare - Health Insurance - FHIR - Claims - Interoperability type: Company image: https://kinlane-productions2.s3.amazonaws.com/apis-json/apis-json-logo.jpg access: 3rd-Party created: '2026-03-21' modified: '2026-05-03' position: Consuming specificationVersion: '0.19' apis: - aid: unitedhealth:optum-api name: UnitedHealth Group Optum API tags: - Healthcare - FHIR - Patient Access - Provider Directory - Drug Formulary - CMS Interoperability baseURL: https://api.uhc.com/fhir/R4 humanURL: https://www.uhc.com/legal/interoperability-apis description: >- The UnitedHealth Group interoperability APIs provide FHIR R4-compliant access to healthcare data including patient records, claims history, provider directories, and formulary information in compliance with CMS interoperability rules. Operates under the Optum platform serving UnitedHealthcare, Medicare & Retirement, Community & State, and Optum health services. properties: - url: https://www.uhc.com/legal/interoperability-apis type: Documentation - url: openapi/unitedhealth-optum-api-openapi.yml type: OpenAPI - url: json-schema/optum-fhir-bundle-schema.json type: Schema - url: json-schema/optum-fhir-patient-schema.json type: Schema - url: json-ld/unitedhealth-optum-api-context.jsonld type: JSON-LD Context - url: examples/optum-fhir-patient-example.json type: Example features: - name: FHIR R4 Patient Access API description: >- CMS-mandated FHIR R4 Patient Access API providing members and third-party applications with access to claims, EOBs, coverage details, and clinical data. - name: Provider Directory API description: >- FHIR R4 Provider Directory implementing Da Vinci PDex Plan Net IG for searching UnitedHealth Group network practitioners and organizations. - name: Drug Formulary API description: >- FHIR R4 Drug Formulary API implementing Da Vinci Drug Formulary IG for accessing prescription drug coverage tiers, prior auth requirements, and quantity limits. - name: Claims History Access description: >- FHIR ExplanationOfBenefit resources providing comprehensive claims history including service details, diagnosis codes, and payment adjudication. - name: Clinical Data Exchange description: >- FHIR Condition and clinical data resources for member health history as reflected in claims and available clinical records. - name: Coverage Information description: >- FHIR Coverage resources for current and historical insurance coverage details across UnitedHealthcare commercial, Medicare, and Medicaid plans. useCases: - name: Patient Portal Health Data description: >- Enable patient portals to display complete health records including claims, coverage, and conditions using FHIR Patient Access APIs. - name: Care Coordination Apps description: >- Build care management tools that aggregate member health history, coverage, and clinical data for population health management. - name: Provider Network Search description: >- Develop provider search applications using the FHIR Provider Directory to help members find in-network physicians and specialists. - name: Prescription Benefit Transparency description: >- Integrate drug formulary data into clinical and patient-facing applications to show coverage tiers and prior authorization requirements. - name: CMS Compliance Applications description: >- Build CMS-compliant third-party applications leveraging UnitedHealth Group's FHIR R4 interoperability infrastructure for data portability. - name: Claims Analytics description: >- Access structured claims data as FHIR ExplanationOfBenefit resources for population health analytics and care gap identification. integrations: - name: Apple Health Records description: >- UnitedHealth Group FHIR Patient Access API integrates with Apple Health Records for member health data access on iOS devices. - name: CommonWell Health Alliance description: >- UnitedHealth Group participates in CommonWell for FHIR-based health information exchange across provider networks. - name: Carequality description: >- FHIR data exchange integration through Carequality framework for nationwide health information network connectivity. - name: Da Vinci Project description: >- UnitedHealth Group implements Da Vinci IGs for payer data exchange including PDex Plan Net for provider directory and Drug Formulary IG. artifacts: openapi: - name: UnitedHealth Group Optum API url: openapi/unitedhealth-optum-api-openapi.yml jsonSchema: - url: json-schema/optum-fhir-bundle-schema.json - url: json-schema/optum-fhir-patient-schema.json - url: json-schema/optum-fhir-explanation-of-benefit-schema.json - url: json-schema/optum-fhir-coverage-schema.json - url: json-schema/optum-fhir-practitioner-schema.json - url: json-schema/optum-fhir-medication-knowledge-schema.json jsonStructure: - url: json-structure/optum-fhir-bundle-structure.json - url: json-structure/optum-fhir-patient-structure.json - url: json-structure/optum-fhir-explanation-of-benefit-structure.json - url: json-structure/optum-fhir-coverage-structure.json - url: json-structure/optum-fhir-practitioner-structure.json - url: json-structure/optum-fhir-medication-knowledge-structure.json jsonLd: - url: json-ld/unitedhealth-optum-api-context.jsonld examples: - url: examples/optum-fhir-patient-example.json - url: examples/optum-fhir-bundle-example.json - url: examples/optum-fhir-coverage-example.json - url: examples/optum-fhir-practitioner-example.json - url: examples/optum-fhir-medication-knowledge-example.json spectralRules: - url: rules/unitedhealth-spectral-rules.yml capabilities: shared: - url: capabilities/shared/optum-api.yaml workflows: - url: capabilities/health-data-interoperability.yaml vocabulary: - url: vocabulary/unitedhealth-vocabulary.yaml maintainers: - FN: Kin Lane email: kin@apievangelist.com