Optum

Supergood | Optum API

Alex Klarfeld

Alex Klarfeld

— 6 min read
Supergood | Optum API

Optum is healthcare technology used by payers and programs to manage authorizations, eligibility, EVV (in certain programs), and reimbursement. With an unofficial API from Supergood, you could create and verify EVV visits, synchronize member and provider rosters from your EHR, validate authorizations, assemble and submit claims, and reconcile payments end to end.

If you’re a clinic, provider group, or a business running revenue cycle operations, integrating your tech stack with Optum can let you pull real-time authorizations and visit statuses, push EHR schedules into EVV, and tie verified visits directly to Medicaid reimbursement—especially helpful for Massachusetts (MassHealth) workflows where EVV and payer rules drive submission compliance. A different tech company integrating with Optum might pull member demographics, authorizations, provider enrollment data, claim statuses, and remittance summaries, while pushing visit check-in/out events, compliance reason codes, and claims files. That unlocks features like authorization-aware scheduling, automated exception resolution, and reconciliation dashboards.

Programmatically access Electronic Visit Verification (EVV), authorizations, eligibility, visit verification, and Medicaid reimbursement workflows in Optum with a stable REST API. Supergood builds and operates production-grade, unofficial Optum integrations so your team can automate critical EVV and billing pipelines without heavy custom engineering.

Optum is used by clinics, provider groups, and revenue cycle teams to manage authorization workflows, validate eligibility, reconcile claims, and—where Optum provides EVV connectivity—document and verify visits to comply with federal and state mandates. With an unofficial API, you could create and verify EVV visits, synchronize patient and caregiver rosters from your EHR, retrieve payer authorizations, bundle verified visits into claims, and reconcile payments—end to end.

If you’re a clinic, provider group, or revenue cycle team, integrating your tech stack with Optum unlocks concrete data flows and features:

  • Pull: Member/patient profiles, provider rosters and NPIs, payer authorizations, eligibility results, visit statuses and exception queues, claim statuses, remittance summaries (835)
  • Push: New/updated members and providers from your EHR, scheduled visits, EVV check-in/out events, visit edits with compliant reason codes, claim submissions referencing verified visits
  • Build: Authorization-aware scheduling, real-time EVV exception resolution, automatic claim assembly for 837P/I, reconciliation dashboards driven by EVV and remittance data

What is Optum?

Optum (a UnitedHealth Group company) provides payer and health system technology spanning authorization management, eligibility verification, provider directory and enrollment, claims submission and remittance, analytics, and in some state programs, EVV connectivity for home and community-based services. Optum’s developer resources include services for claims and remittances (EDI 837/835), eligibility (270/271), and prior authorizations, alongside portals used by providers to manage EVV visits and reimbursement tasks.

Core product areas include:

  • Electronic Visit Verification (mobile/telephony and aggregator connections, where enabled by the program)
  • Authorization management (prior auths, service codes, units)
  • Eligibility verification and payer program enrollment
  • Provider directory, NPIs, and enrollment data
  • Claims submission and remittance retrieval for Medicaid/MCO
  • Compliance reporting for visit documentation and reimbursement

Common data entities:

  • Members/Patients (Medicaid beneficiaries)
  • Providers (clinics, groups, caregivers, billing providers)
  • Visits (EVV check-in/out, service codes, tasks, verification metadata)
  • Authorizations (payer/program, service code, units, validity dates)
  • Payers/Programs (e.g., MassHealth Medicaid)
  • Schedules and assignments
  • Exceptions (late/missing events, GPS mismatch, overlapping visits)
  • Claims (837P/I service lines referencing verified visits)
  • Remittances (835 summaries for reconciliation)

The Optum Integration Challenge

Organizations rely on Optum daily, but turning portal-based workflows into automated pipelines is hard:

  • Program- and payer-specific rules: Each Medicaid program may require distinct service codes, modifiers, and EVV validation logic
  • Enterprise security: SSO/MFA and network controls complicate headless automation
  • Portal-first delivery: Key EVV and authorization handling lives in web apps or batch exports, not unified public APIs
  • EDI/SFTP interfaces and timing: 837/835 batching constraints and daily submission windows must be respected
  • Compliance nuances: Visit edits require compliant reason codes and audit trails; data retention rules vary by jurisdiction

How Supergood Creates Optum APIs

Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.

  • Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
  • Maintains session continuity with automated refresh and change detection
  • Normalizes EVV, authorization, and claim objects so you can integrate once across programs
  • Aligns with customer entitlements and licensing constraints to ensure compliant access
  • Bridges batch exports and SFTP/EDI flows where applicable with signed URL retrieval and delivery

Use Cases

EHR-to-EVV Synchronization

  • Push patient and provider rosters from your EHR into Optum-managed EVV programs
  • Create visits automatically from your scheduling system with correct service codes and modifiers
  • Maintain a single source of truth for demographics and eligibility

Authorization-Aware Scheduling and Eligibility

  • Validate authorizations before scheduling or visit creation
  • Track remaining authorized units and prevent over-utilization
  • Surface program-specific rules to care coordinators

EVV Exception Resolution

  • Pull exception queues and route issues (e.g., late arrival, missing check-out, GPS mismatch) to staff for resolution
  • Apply compliant reason codes on visit edits with audit trails
  • Escalate unresolved exceptions prior to claim submission

Claims Generation and Reimbursement Automation

  • Bundle verified visits into 837P/I claims with payer-specific formatting
  • Submit via the configured channel (state portal, MCO gateway, or clearinghouse)
  • Track claim statuses and reconcile remittances alongside EVV evidence

Audit and Compliance

  • Export complete visit packets with timestamps, locations, signatures, and reason codes
  • Maintain machine-readable audit trails aligned to program requirements
  • Prove EVV coverage and claim provenance during reviews

Available Endpoints

Authentication

POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {
      "type": "totp",
      "code": "123456"
    }
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_5f21c9",
    "name": "RCM Admin",
    "entitlements": ["evv", "authorizations", "claims", "remittances"]
  }
}

Authorizations

GET /evv/authorizations: Retrieve payer/member service authorizations with allowed units, service codes, and validity dates. Use this to validate scheduling and claim eligibility, including Massachusetts (MassHealth) programs.

Query parameters

  • memberId: string
  • providerNpi: string
  • serviceCode: string (HCPCS)
  • activeOn: ISO 8601 date
  • payerId: string (e.g., "payer_ma-masshealth")

Example response

{
  "items": [
    {
      "authorizationId": "auth_9b12e1",
      "authorizationNumber": "PA-2026-18437",
      "memberId": "mem_c8402d",
      "memberName": "Casey Nguyen",
      "providerNpi": "1760458392",
      "payerId": "payer_ma-masshealth",
      "program": "HCBS",
      "serviceCode": "T1019",
      "modifiers": ["U1"],
      "unitsAuthorized": 96,
      "unitsRemaining": 72,
      "startDate": "2026-01-01",
      "endDate": "2026-03-31",
      "status": "active"
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

EVV Visits

POST /evv/visits: Create or update an EVV visit record with check-in/out events, service details, and verification metadata. Supports compliant edit reason codes used for MassHealth reimbursement workflows.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/evv/visits \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "memberId": "mem_c8402d",
    "caregiverId": "cgv_21a0aa",
    "authorizationId": "auth_9b12e1",
    "payerId": "payer_ma-masshealth",
    "serviceCode": "T1019",
    "modifiers": ["U1"],
    "checkIn": {
      "timestamp": "2026-01-19T14:02:33Z",
      "method": "mobile",
      "location": {"lat": 42.3601, "lng": -71.0589},
      "deviceId": "ios-12a3"
    },
    "checkOut": {
      "timestamp": "2026-01-19T15:01:47Z",
      "method": "mobile",
      "location": {"lat": 42.3602, "lng": -71.0587}
    },
    "tasks": ["medication_reminder", "meal_prep"],
    "notes": "Client requested meal prep and light housekeeping.",
    "verification": {"gpsMatch": true, "signatureCapture": true},
    "editReasonCodes": [],
    "referenceId": "ehr-schedule-42391"
  }'

Example response

{
  "visitId": "vst_7de301",
  "status": "verified",
  "exceptions": [],
  "createdAt": "2026-01-19T15:02:02Z",
  "referenceId": "ehr-schedule-42391"
}

Claims

POST /claims: Assemble an 837P/I claim from verified visits. Supergood normalizes service lines and can route the generated file to the configured submission channel (e.g., MassHealth portal, MCO gateway, or clearinghouse).

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/claims \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "claimType": "837P",
    "payerId": "payer_ma-masshealth",
    "billingProvider": {
      "npi": "1234567890",
      "taxonomy": "Home Health",
      "name": "BayState Community Care",
      "billingAddress": {
        "line1": "100 Care Way",
        "city": "Boston",
        "region": "MA",
        "postalCode": "02108"
      }
    },
    "visits": [
      {"visitId": "vst_7de301", "units": 4, "serviceCode": "T1019", "modifiers": ["U1"]}
    ],
    "submissionChannel": "state_portal",
    "referenceId": "billing-batch-jan19"
  }'

Example response

{
  "claimId": "clm_91bf70",
  "status": "queued",
  "edi": {"format": "837P", "size": 50218},
  "submissionChannel": "state_portal",
  "createdAt": "2026-01-19T16:05:42Z",
  "reviewUrl": "https://download.optum.example/signed/abc123...",
  "referenceId": "billing-batch-jan19"
}

Get full API Specs →

Technical Specifications

  • Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
  • Response format: JSON with consistent resource schemas and pagination
  • Rate limits: Tuned for enterprise throughput while honoring licensing and usage controls
  • Session management: Automatic reauth and cookie/session rotation with health checks
  • Data freshness: Near real-time retrieval of visits, authorizations, and claim artifacts
  • Security: Encrypted transport, scoped tokens, and audit logging; respects Optum entitlements and compliance requirements
  • Webhooks: Optional asynchronous delivery for exceptions, claim generation, and remittance updates

Performance Characteristics

  • Latency: Sub-second responses for list/detail queries under normal load
  • Throughput: Designed for high-volume EVV and batch claims pipelines
  • Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
  • Adaptation: Continuous monitoring for UI/API changes with rapid adapter updates

Getting Started

  1. Schedule Integration Assessment

Book a 30-minute session to confirm your Optum product mix, licensing, and authentication model.

  1. Supergood Builds and Validates Your API

We deliver a hardened Optum adapter tailored to your workflows and entitlements.

  1. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as Optum evolves.

Schedule Integration Call →

Frequently Asked Questions

Q: Which Optum products can this integration cover?

Supergood supports workflows across commonly used Optum portals and payer-facing tools, subject to your licensing and entitlements. We scope coverage (e.g., EVV, authorizations, eligibility, visit exports, claim assembly, remittance retrieval) during integration assessment.

Q: How are MFA, SSO, and batch interfaces handled for automation?

We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For batch flows, we manage SFTP/EDI timing windows, generate 837 files, and retrieve signed URLs or delivery confirmations programmatically.

Q: Can I generate claims directly from verified visits for MassHealth?

Yes. You can assemble 837P/I from verified visits with payer-specific formatting and submit via your configured channel. We return statuses and artifacts for reconciliation alongside EVV evidence.

Ready to automate your Optum workflows?

Supergood can have your Optum integration live in days with no ongoing engineering maintenance.

Get Started →

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