UnitedHealthcare interoperability APIs
UnitedHealthcare’s interoperability APIs enable secure, standards-based data exchange across payers, providers, and members. Built on FHIR, these APIs support patient access, provider access, and payer-to-payer data sharing, ensuring continuity when members change plans. They also streamline prior authorization processes and incorporate the California Data Exchange Framework (DxF) for secure sharing of health and social services information. Together, these solutions improve interoperability, reduce administrative burden, and enhance care coordination across the healthcare ecosystem.
Patient access API
The patient access API lets UnitedHealthcare members securely access their health data through apps of their choice. Built on HL7 FHIR standards, it provides claims, encounter details, and key clinical information like diagnoses, procedures, and medications. Using OAuth 2.0 for authentication, it meets CMS interoperability requirements while ensuring privacy. This API empowers members, drives innovation, and enhances the healthcare experience.
Payer-to-payer API
The payer-to-payer API enables members to transfer their health data when switching plans. Built on HL7 FHIR standards, it allows a new payer to securely request and retrieve a member’s clinical history from the previous payer. This supports CMS interoperability requirements, ensures continuity of care, and reduces administrative burden by providing accurate, up-to-date claims and clinical information.
Coming soon
Provider access API
The provider access API lets providers securely request a patient’s clinical data from the payer when there is an active treatment relationship. Built on HL7 FHIR standards, it supports CMS interoperability requirements and streamlines data exchange, reducing administrative burden. Typical data includes claims, clinical records, medications, and encounter details, helping improve care coordination and decision-making.
Coming soon
Prior authorization API
The prior authorization API simplifies the prior authorization process using three HL7 FHIR-based APIs compliant with CMS-0057-F. These include Coverage Requirement Discovery (CRD) to check if prior authorization is needed, Documentation Templates and Rules (DTR) to gather required documentation, and Prior Authorization Support (PAS) for electronic submission and status updates. Together, they reduce delays, cut administrative burden, and improve provider experience while accelerating patient care.
Coming soon
California data transfer framework
DxF provides a secure, standardized way to share health and social services information across organizations. It connects medical, behavioral, and social data to support whole-person care, reduce administrative burden, and improve patient experience. Built on modern interoperability principles and aligned with state mandates, DxF ensures privacy and promotes coordinated, equitable care.
Coming soon