# Optum Claims & Billing MCP for AI Agents AI Agent Connect > Optum Claims & Billing MCP automates medical claim submissions, status tracking, and ERA remittance processing. It handles 837P and 837I payloads for UnitedHealthcare, manages EDI 276/277 status checks, and pulls 835 ERA remittance advices to reconcile bank accounts. ## Overview - **Category:** industry-titans - **Price:** Free - **Endpoint:** https://edge.vinkius.com/vk_preview_e4xPqwMzSwiBQ7KWDfZCZMaVrl034AScFZetyfpc/ai-agent-connect - **Tags:** medical-billing, edi, claims-processing, remittance, healthcare-compliance ## Description Optum Claims & Billing lets you take over the heavy lifting of your hospital back-office. You can automate the construction of 837P and 837I payloads to send bills directly to UnitedHealthcare for payment. Instead of manually checking portals, your agent can intercept pended, denied, or approved bills using the EDI 276/277 framework. It also pulls 835 ERA remittances so you can reconcile bank accounts without the usual spreadsheet headache. This Connector is built for high-security financial workflows, deliberately excluding front-desk actions to keep your clinical data separate. When you add this to the Vinkius catalog, you get a secure way to offload billing disputes to your AI agent. It handles the messy details of medical accounting so you can focus on actual healthcare operations. ## Tools ### opt_check_claim_status Check if a submitted bill has been paid, denied, or is pending medical review. This gives you real-time updates without manual portal checks. ### opt_get_remittance_advice Downloads the Electronic Remittance Advice (835 ERA) detailing payment breakouts. Use this to quickly reconcile your bank accounts. ### opt_handle_denial_revision Resubmits a corrected claim fixing coding errors to overturn a payer denial. This helps you recover lost revenue by fixing mistakes automatically. ### opt_submit_institutional_claim Submits an institutional medical bill (837I) for hospital stays and major facilities. This handles the heavy billing requirements for large centers. ### opt_submit_professional_claim Submits a professional medical bill (837P) for doctors and outpatient clinics. This streamlines the billing process for smaller practices. ## Prompt Examples **Prompt:** ``` Check the status of the institutional claim ID 88829281X. ``` **Response:** ``` Query completed. The medical claim 88829281X is currently Approved and expects a check date on May 15. ``` **Prompt:** ``` List the latest ERA remittances available for clearing. ``` **Response:** ``` Pulled 3 recent ERA 835s from UnitedHealth Group clearinghouse totaling $12,450.00 ready for auto-posting. ``` **Prompt:** ``` Draft an 837 payload for an office visit code 99213. ``` **Response:** ``` The ANSI 837 Professional Claim string has been successfully prepared for code 99213 passing all pre-adjudication compliance checks. ``` ## Capabilities ### Submit medical bills Send 837P or 837I payloads to UnitedHealthcare for payment. ### Track claim status Check if bills are paid, denied, or still pending review. ### Pull remittance data Download 835 ERA reports to reconcile bank deposits. ### Fix claim errors Resubmit corrected claims to overturn payer denials. ### Automate billing updates Get real-time status updates on hospital stays and outpatient bills. ## Use Cases ### Checking high-volume claim statuses A billing clerk sees a high volume of Pended claims. They ask the agent to check the status of all IDs from last week using opt_check_claim_status. ### Automating bank reconciliation An accountant needs to reconcile the bank. They ask the agent to list the latest ERA remittances to get the 835 data for auto-posting. ### Overturning claim denials A clinic gets a denial for a coding error. The user asks the agent to resubmit the corrected claim using opt_handle_denial_revision. ### Batch hospital billing A hospital needs to send a batch of bills for a large facility. They ask the agent to submit the 837I payloads via opt_submit_institutional_claim. ## Benefits - Stop manual status checking. Use opt_check_claim_status to see if bills are paid or denied without opening multiple tabs. - Faster bank reconciliation. Pull 835 ERA reports with opt_get_remittance_advice to match payments to specific claims instantly. - Reduced denial rates. Use opt_handle_denial_revision to quickly fix coding errors and resubmit claims to overturn payer rejections. - Standardized claim submission. Send both 837P and 837I payloads using opt_submit_professional_claim and opt_submit_institutional_claim. - Secure financial handling. The Connector uses OAuth to keep your CLIENT_ID and financial data protected during every transaction. ## How It Works The bottom line is you get a way to let your AI handle the tedious paperwork of medical billing and financial tracking. 1. Insert your financial CLIENT_ID into the runtime module to authorize the connection. 2. Connect the Connector to your AI client through the Vinkius dashboard. 3. Ask your agent to check claim statuses, submit bills, or pull remittance data. ## Frequently Asked Questions **What medical claims can the Optum Claims & Billing MCP handle?** It supports both 837P for professional services and 837I for institutional hospital stays. **Can this Connector help me with UnitedHealthcare billing?** Yes, it is specifically designed to interact with UnitedHealthcare for claim submission and status tracking. **How does the Optum Claims & Billing MCP handle claim denials?** It uses the opt_handle_denial_revision tool to resubmit corrected claims that were previously rejected. **Can I use this for my clinic's front-desk scheduling?** No, this is a back-office tool for billing and finance. It does not handle clinical workflows like scheduling or patient check-ins. **Does the Optum Claims & Billing MCP support ERA remittance advice?** Yes, it can download 835 ERA files to help you reconcile payments with your bank records. **Is it safe to use this for hospital financial data?** The Connector uses the OAuth protocol to ensure your financial credentials and payloads stay secure. **Can this Optum Server check a patient's insurance card status?** No. In adherence to US Healthcare segregation architecture (Least Privilege), Claims processing is totally decoupled from Eligibility. For front-desk validations, install the `optum-eligibility-mcp` array safely. **Is this system capable of sending secondary claims crossing over from Medicare?** Yes. The X12 837 payload infrastructure fully supports coordination of benefits (COB) logic required to submit clean secondary claims dynamically. **How fast are ERA (835) remittances processed by the engine?** ERAs are fetched in real-time as they become available on Optum Clearinghouse networks, expediting auto-posting to your financial ledgers.