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v1

latestOpenAPI 3.0.32026-07-2491720.7 KB
Dental Claim Actions

Dental Claim Actions API

The Dental Claim Action API facilitates dental claim submission in X12 format and returns responses in the 277CA format. It provides a flexible GraphQL endpoint to streamline end-to-end dental claim action processing. Below operation is supported: <strong>SubmitDentalClaim:</strong> Validates if the dental claim submitted is eligible for claim submission and upon validation if the claim is eligible for submission, claim will be submitted.

post/py/oihub/claim/dnt/submit/v1/graphql

Headers

providerTaxIdstring
Example:123456789

Provider Tax ID

x-optum-consumer-correlation-idstring
Example:4d4a8964-e5fa-42dc-a37d-12345789

Correlation ID can be used to trigger the Mock API call for dental claim submission. Use "test_" in order to hit the Mock flow. Example correlation ID : test_dnt-claim-submission-200_success

Request body

querystring required

GraphQL mutation query string

Example request

{
  "query": "mutation claimActions($input: ClaimSubmissionInput!) { claimSubmission(input: $input) { transactionId x12Response277CA message statusCode } }",
  "variables": {
    "input": {
      "x12RequestData": "ISA*00*          *00*          *ZZ*SENDER ID       *ZZ*RECEIVER ID    *231012*1200*U*00501*000000001*0*P*:~ GS*HP*SENDERAPP*RECEIVERAPP*20231012*1200*000000001*X*005010X222A1~ ST*837*0001*005010X222A1~ [... BHT, HL, PRV, N1, N3, N4, CLM, CAS, PLB, HI, DMG, and other 837 segments...] SE*32*0001~ GE*1*000000001~ IEA*1*000000001~",
      "payerId": "88848"
    }
  }
}

Response

SubmitDentalClaim

Success Response:

  • 000 - Dental claim submitted successfully. Refer 277CA for validation outcomes.

Error Codes (Global Codes):

  • REQ_401 - Unauthorized: Missing/invalid/expired credentials or token

  • REQ_422 - Validation failed: Request is syntactically valid but fails semantic validation

  • REQ_500 - Internal server error: Unexpected error

  • REQ_503 - Service unavailable: Downstream service is currently unavailable

  • REQ_504 - Gateway timeout: Upstream dependency timed out

  • GTW_06 - TA1 Rejection: TA1 acknowledgment indicates envelope failure

  • GTW_08 - Unknown Document: Gateway does not recognize document structure

  • GTW_11 - Service Failure: General processing error at the downstream service

  • GTW_12 - Downstream Timeout: Payer system failed to respond within SLA

  • GTW_13 - Persistence Error: Internal storage failure at the gateway

  • GTW_14 - Ack Failure: Failure generating downstream 999/277 files

  • GTW_15 - Config Error: Downstream environment configuration mismatch

  • EDI_200 - Wrong Claim Type: Expected 837D (Dental)

  • EDI_203 - Batch Not Allowed: Multiple ST-SE segments detected. Single-claim submissions only

  • EDI_206 - Invalid segment: One or more segments are invalid, out of order, or not allowed

Example response

{
  "data": {
    "claimSubmissionResponse": {
      "transactionId": "8841512345678901",
      "x12Response277CA": "ISA*00*          *00*          *ZZ*87726          *ZZ*B00099999805   *250911*1927*^*00501*000000000*0*P*:~GS....~GE*1*0~IEA*1*000000000~",
      "message": "Claim submitted successfully. Refer 277CA for validation outcomes.",
      "statusCode": "000"
    }
  }
}