MCP For Claude Marketplace
Optum Eligibility

Optum Eligibility MCP Connector for Claude

A+

Verify patient active healthcare coverage, extract deductibles, and run real-time UHG demographics.

5 tools Official Updated Jun 28, 2026 Official Vinkius Partner
More Details Connect to Claude

What you can do

Take complete proxy control over your Medical Front-Desk operations, accelerating the intake of patients with automated real-time checks acting securely under Optum APIs:

  • Check Active Eligibility: Run advanced X12 270/271 mappings extracting if a patient holds an active healthcare policy seamlessly.
  • Verify Deductibles: Quickly identify out-of-pocket limits and met thresholds for an individual efficiently.
  • Check Provider Network: Look up if a specific doctor or facility operates strictly 'In-Network'.

How it works

  1. High Security & Compliance: Engineered entirely to handle Front-Desk requests (Reading PHI Demographics/Status only). This architecture deliberately excludes Financial/Claim mutations.
  2. Engage OAuth Protocol: Authorize directly substituting your institutional CLIENT_ID securely within the runtime module.
  3. Deploy: Offload reception verification workflows immediately.

Who is this for?

Specifically built for Hospital Receptionists, Clinic Managers, and Healthcare Tech Integrators.

patient-eligibilityinsurance-verificationhealthcare-dataphi-management

5 tools expose this connector's capabilities to your AI agent.

opt_check_eligibility

Verify if a patient has active healthcare coverage. Maps to X12 270/271 EDI transactions securely

opt_get_benefit_details

Pulls granular coverage rules indicating if a specific medical service requires prior authorization

opt_get_deductibles

Extract remaining out-of-pocket maximums and deductibles for a specific health plan member

opt_search_patient_demographics

Search the healthcare database for a patient record matching specific demographic parameters securely

opt_verify_provider_network

Checks if a specific doctor or medical facility is In-Network for the given patient policy

See how to talk to your AI agent using Optum Eligibility.

Check the remaining deductibles and out-of-pocket maximum amounts for patient ID 99281.

Query completed. Patient 99281 has a remaining active deductible of $1,250 towards an annual ceiling.

Find if John Doe is currently eligible for an MRI under policy HDHP-77.

Eligibility verified. John Doe is active under HDHP-77 but MRIs require prior authorization before service delivery.

List all dependents covered under Member ID UB-11202.

Located dependents under subscriber UB-11202: 1 Spouse (Active) and 2 Toddler dependents (Active) currently attached.

Absolutely strictly not. Per rigorous Least Privilege modeling common to US Healthcare operations, Front-Desk tasks (Eligibility) are decoupled natively from Back-Office operations. For submitting medical claims, integrate the `optum-claims-mcp` array safely.

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