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Optum Real Coordination of Benefits Intelligence

Help reduce payer costs with real time coordination of benefits checks.

Real Coordination of Benefits Intelligence (COB) is an API that empowers payers with real time coordination of benefits insights, reducing administrative burden and improving claim accuracy from the start. By automating eligibility checks and instantly detecting other coverage, the solution minimizes rework, lowers costs, and accelerates payment cycles. This solution helps support operational efficiency, cleaner claims, and more consistent member experiences for payers.

Packages starting as low as

Identify and validate primary coverage

This API uses a comprehensive dataset of eligibility records from multiple health plans to support more accurate and efficient claims processing. It helps determine the correct order of coverage, reducing information gaps that can lead to billing errors, eligibility denials and recovery inefficiencies.

Help prevent denials due to COB errors

By identifying the correct primary payer before claim submission, the solution helps reduce eligibility errors, alleviate administrative rework associated with claims processing, and minimize unnecessary overpayments and rebilling.

Help lower costs and accelerate payment cycles

Reduce error driven expenses and streamline claim handling. With fewer reroutes and corrections, payers experience faster processing, improved operational efficiency and more predictable payment cycles.

Developer Resources

Real Coordination of Benefits Intelligence API

API Documentation
Request sandbox

 

Access detailed endpoint guides,
schemas, and sample payloads to
support implementation.

 

Test API behavior and validate
integration using a try before you
buy sandbox environment.

Frequently Asked Questions

Q: Can payers test the Real Coordination of Benefits Intelligence API before purchasing?

A: Yes. A try before you buy sandbox is available, allowing developers to explore API behavior, review sample responses, and validate integration steps. Sandbox credentials can be requested through the Developer Portal or an Optum representative here. 

Q: What integration resources are available for developers?

A: Developers have access to comprehensive API documentation, including endpoint guides, schema details, sample payloads, and sandbox testing tools. These resources are designed to streamline implementation and accelerate time to value.

Q: Is the Coordination of Benefits Intelligence API designed for providers or payers?

A: This API is designed specifically for payers in health care. Real-time COB API supports payer workflows such as primary payer determination and pre‑payment coordination of benefits validation. Providers should refer to Optum Real solutions for provider‑focused coordination‑of‑benefits needs.

What types of organizations benefit most from Real Coordination of Benefits Intelligence?

A: Health plans, third‑party administrators, and payer‑focused health technology platforms benefit most—particularly organizations seeking to reduce eligibility‑related denials, improve claim accuracy, or automate COB validation within existing workflows.

Q: How does the API determine coordination of benefits information in real time?

The API queries eligibility and coverage data across multiple health plans to confirm the correct order of coverage. This automated approach helps close information gaps that commonly lead to denials and downstream claim corrections.

Q: Is there a way to test the API?

A: Yes. A sandbox environment is available to test API responses before signing a contract. The sandbox provides canned responses and cannot access production‑level data. Sandbox credentials can be requested through your Optum representative or via the Developer Portal.

Q: Which Optum solutions support payment and revenue workflows?

A: Our AI Marketplace is a platform designed to simplify the exploration and adoption of artificial intelligence solutions within the health care sector. It offers a curated selection of AI-driven tools and services aimed at enhancing various aspects of health care delivery and administration. Key offerings include:

  • SmartPay Plus: An e-cashiering payment platform that helps streamline patient payments and the collection process for providers and health technology companies 
  • Revenue Performance Advisor: A tool that simplifies complex tasks across the revenue cycle, utilizing advanced health care technology to improve efficiency  
  • Optum Advisory Stepwise Underwriting Cost Predictors: Customizable underwriting services employing advanced machine learning models to help estimate future costs for underwriting and actuarial needs  
  • Prior Authorization Inquiry API: An API enabling providers, partners, and health tech companies to check a patient’s prior authorization status from payers in real time, accepting and returning requests in EDI-X12 or JSON formats 

The marketplace also features collaborations with trusted resellers offering their own innovative health care solutions, fostering an ecosystem that helps support the industry through smart solutions.

Marketplace updates

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