slug: unitedhealthcare
provider: UnitedHealthcare
generated_by: planning/capability-mapping/scripts/classify_capabilities.py
model: claude-opus-5
frame:
- Healthcare Providers
min_confidence: 0.7
capability_model:
  source: https://github.com/vincentmakes/turbo-ea-capabilities
  license: CC-BY-4.0
  attribution: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities,
    CC BY 4.0
  notice: NOTICE
edge_count: 3
edges:
- tag: Eligibility
  spec_file: unitedhealthcare-eligibility-api-openapi.yml
  capability_id: BC-2800.30
  capability_id_l1: BC-2800
  capability_name: Eligibility & Benefits Verification
  confidence: 0.9
  evidence: POST /eligibility/v1/real-time  checkEligibility  Real-Time Eligibility Check; POST /eligibility/v1/patient-benefit-check  checkPatientBenefit
  reason: Operations perform real-time insurance eligibility and patient benefit verification, which is
    precisely eligibility and benefits verification before service delivery.
- tag: Claims
  spec_file: unitedhealthcare-claims-api-openapi.yml
  capability_id: BC-2870.30
  capability_id_l1: BC-2870
  capability_name: Claim Production & Submission
  confidence: 0.78
  evidence: POST /claims/v1/pre-check  claimPreCheck; POST /claims/v1/inquiry  inquireClaim; schemas ClaimInquiryRequest,
    ClaimPreCheckResponse
  reason: Provider-facing claim pre-check (scrubbing before submission) and claim status inquiry map to
    claim production, scrubbing and status tracking within healthcare revenue cycle.
- tag: Patient Access
  spec_file: unitedhealthcare-patient-access-api-openapi.yml
  capability_id: BC-2900.60
  capability_id_l1: BC-2900
  capability_name: Healthcare Interoperability Operations
  confidence: 0.7
  evidence: '"These APIs enable patients and authorized third parties to access health data using standard
    FHIR resources"; GET /Coverage listCoverage; GET /ExplanationOfBenefit'
  reason: FHIR resource endpoints supporting patient-initiated data sharing under the CMS Interoperability
    rule realise healthcare interoperability operations.