UnitedHealth Group Optum API — Patient Access

naftiko: 1.0.0-alpha2
info:
  label: UnitedHealth Group Optum API — Patient Access
  description: 'UnitedHealth Group Optum API — Patient Access. 3 operations. Lead operation: UnitedHealth Group List Member
    Coverage. Self-contained Naftiko capability covering one Unitedhealth business surface.'
  tags:
  - Unitedhealth
  - Patient Access
  created: '2026-05-19'
  modified: '2026-05-19'
binds:
- namespace: env
  keys:
    UNITEDHEALTH_API_KEY: UNITEDHEALTH_API_KEY
capability:
  consumes:
  - type: http
    namespace: optum-patient-access
    baseUri: https://api.uhc.com/fhir/R4
    description: UnitedHealth Group Optum API — Patient Access business capability. Self-contained, no shared references.
    resources:
    - name: Coverage
      path: /Coverage
      operations:
      - name: listcoverage
        method: GET
        description: UnitedHealth Group List Member Coverage
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        inputParameters:
        - name: patient
          in: query
          type: string
          description: Patient resource ID
          required: true
        - name: status
          in: query
          type: string
          description: Coverage status filter
    - name: ExplanationOfBenefit
      path: /ExplanationOfBenefit
      operations:
      - name: listexplanationofbenefit
        method: GET
        description: UnitedHealth Group List Claims as Explanation of Benefit
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        inputParameters:
        - name: patient
          in: query
          type: string
          description: Patient resource ID to retrieve ExplanationOfBenefits for
          required: true
        - name: type
          in: query
          type: string
          description: Claim type filter (professional, institutional, pharmacy, oral)
        - name: _lastUpdated
          in: query
          type: string
          description: Filter by last updated date/time in FHIR date format
        - name: service-date
          in: query
          type: string
          description: Filter by service date (FHIR date format)
        - name: _count
          in: query
          type: integer
          description: Maximum number of results per page
        - name: _offset
          in: query
          type: integer
          description: Pagination offset
    - name: Patient-id
      path: /Patient/{id}
      operations:
      - name: getpatient
        method: GET
        description: UnitedHealth Group Get Patient Demographics
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        inputParameters:
        - name: id
          in: path
          type: string
          description: FHIR Patient resource logical ID (maps to member ID)
          required: true
    authentication:
      type: bearer
      token: '{{env.UNITEDHEALTH_API_KEY}}'
  exposes:
  - type: rest
    namespace: optum-patient-access-rest
    port: 8080
    description: REST adapter for UnitedHealth Group Optum API — Patient Access. One Spectral-compliant resource per consumed
      operation, prefixed with /v1.
    resources:
    - path: /v1/coverage
      name: coverage
      description: REST surface for Coverage.
      operations:
      - method: GET
        name: listcoverage
        description: UnitedHealth Group List Member Coverage
        call: optum-patient-access.listcoverage
        with:
          patient: rest.patient
          status: rest.status
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/explanationofbenefit
      name: explanationofbenefit
      description: REST surface for ExplanationOfBenefit.
      operations:
      - method: GET
        name: listexplanationofbenefit
        description: UnitedHealth Group List Claims as Explanation of Benefit
        call: optum-patient-access.listexplanationofbenefit
        with:
          patient: rest.patient
          type: rest.type
          _lastUpdated: rest._lastUpdated
          service-date: rest.service-date
          _count: rest._count
          _offset: rest._offset
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/patient/{id}
      name: patient-id
      description: REST surface for Patient-id.
      operations:
      - method: GET
        name: getpatient
        description: UnitedHealth Group Get Patient Demographics
        call: optum-patient-access.getpatient
        with:
          id: rest.id
        outputParameters:
        - type: object
          mapping: $.
  - type: mcp
    namespace: optum-patient-access-mcp
    port: 9090
    transport: http
    description: MCP adapter for UnitedHealth Group Optum API — Patient Access. One tool per consumed operation, routed inline
      through this capability's consumes block.
    tools:
    - name: unitedhealth-group-list-member-coverage
      description: UnitedHealth Group List Member Coverage
      hints:
        readOnly: true
        destructive: false
        idempotent: true
      call: optum-patient-access.listcoverage
      with:
        patient: tools.patient
        status: tools.status
      outputParameters:
      - type: object
        mapping: $.
    - name: unitedhealth-group-list-claims-explanation
      description: UnitedHealth Group List Claims as Explanation of Benefit
      hints:
        readOnly: true
        destructive: false
        idempotent: true
      call: optum-patient-access.listexplanationofbenefit
      with:
        patient: tools.patient
        type: tools.type
        _lastUpdated: tools._lastUpdated
        service-date: tools.service-date
        _count: tools._count
        _offset: tools._offset
      outputParameters:
      - type: object
        mapping: $.
    - name: unitedhealth-group-get-patient-demographics
      description: UnitedHealth Group Get Patient Demographics
      hints:
        readOnly: true
        destructive: false
        idempotent: true
      call: optum-patient-access.getpatient
      with:
        id: tools.id
      outputParameters:
      - type: object
        mapping: $.