Tools · Paid Paid tool

Eligibility Network

Third-party Optum eligibility AccuMed sells separately from medical billing RCM (X12 270 → 271). Network customers get single/bulk checks, quotas, and optional claims — Optum credentials stay on AccuMed’s secure API.

Separate Eligibility Network login

Eligibility accounts are not billing portal clients. Production single/bulk checks use the Eligibility Network portal (JWT, rate limits, lockouts, server-side Optum OAuth).

Eligibility Network login Buy eligibility access Billing Client Portal

Optum Marketplace & EDI

This tool is designed around Optum’s Eligibility API model: OAuth2 bearer tokens, HTTPS JSON requests that represent standard X12 EDI 270 eligibility inquiries, and 271-style benefit responses (plan status, copay, coinsurance, deductible, and more).

Official docs: Eligibility V3 guide · Optum Marketplace · Request sandbox

Optum Market EDI — terms acceptance

You must acknowledge these conditions before running eligibility checks. They reflect Optum Marketplace / Eligibility & Claims API usage rules AccuMed requires for this paid tool.

Authorized use only. Eligibility inquiries may be submitted only for legitimate healthcare operations (treatment, payment, or healthcare operations) by authorized AccuMed clients and staff. Do not use this tool for unauthorized marketing, scraping, or speculative lookups.
Marketplace subscription & credentials. Sandbox credentials may be requested from Optum without a financial obligation for learning canned responses. Production access requires a signed Optum contract or processed Marketplace subscription and separate production credentials. AccuMed’s paid tool fees do not replace Optum’s own Marketplace fees.
Sandbox limits. Sandbox returns predefined/canned responses. Do not send real PHI, perform load testing, or treat sandbox output as confirmation of live coverage. Use Optum’s predefined test values when exercising sandbox.
Security & OAuth. Optum APIs are HTTPS-only and protected by OAuth2 bearer tokens (client_id / client_secret). Secrets must stay on a secure AccuMed server/proxy — never embed production secrets in public web pages or share them with unauthorized parties.
EDI accuracy. Requests follow X12 270 semantics (payer trading partner ID, provider NPI, subscriber identifiers, service type codes, dates). You are responsible for accurate data entry; payers may reject incomplete or non-compliant inquiries.
No Optum endorsement of results display. Benefit displays in this UI are for operational convenience. Final coverage determinations remain with the payer. Optum and AccuMed are not liable for decisions made solely on tool output.
HIPAA & confidentiality. Treat all member data as PHI. Use minimum necessary information, secure workstations, and AccuMed’s BAA / privacy practices. Do not email unsecured PHI or store exports on unmanaged devices.
Vendor / TIN association. Where AccuMed or a software vendor uses Optum on behalf of a practice, provider TINs must be associated per Optum Marketplace onboarding. Misuse of another organization’s credentials is prohibited.
Changes & companion guides. Payer-specific companion guide requirements may apply. Optum and payer rules can change; you agree to follow current Optum Developer Portal guidance and AccuMed instructions.
Audit. AccuMed may log eligibility usage for billing of this paid tool, quality, and compliance. Optum may impose additional audit or acceptable-use requirements under your Marketplace agreement.

This summary supports AccuMed’s product workflow. Your binding Optum Marketplace / API agreement with Optum (and AccuMed service agreement) controls if there is any conflict. Review Optum’s latest terms on the Marketplace and Developer Portal before production go-live.

Full name (acknowledgment)

I have read and agree to use this paid Eligibility tool under the Optum Market EDI / Marketplace conditions above and AccuMed’s policies.

Eligibility inquiry (270)

Payer / trading partner ID *

Service type code

Provider NPI *

Provider / org name

Member ID *

Date of service

First name

Last name

Date of birth

Gender

Ask about paid access

Demo tip: use member ID containing INACTIVE to see an inactive sample response.

Connection

Mode

Proxy base URL

Proxy must implement OAuth with Optum and POST /eligibility/v3. Do not paste client_secret here.

Request preview (JSON)

{}

Need production Optum eligibility as a third-party service?

AccuMed resells Optum eligibility (single/bulk) on a separate Eligibility Network — independent of medical billing RCM client accounts.

Talk to AccuMed Open Eligibility Network