• PROFESSIONAL
  • INSTITUTIONAL
  • PAYER
  • HUMAN

How to submit medical claims with your AI

Connect Optum Claims & Billing once. After that, your agent handles the heavy lifting of EDI payload construction and transmission.

Ask AI about this page

Short answer

How do I submit medical claims with my AI?

Tell your agent to generate and transmit 837P or 837I EDI payloads. It will format the data and send it straight to the payer. You'll see the results of these transmissions below.

Claim outcomes

Where your claims end up.

The AI handles the technical EDI work, routing the data to these specific outcomes.

PROFESSIONAL

837P Payloads

The agent builds professional claim files. These go directly to the payer for processing.

INSTITUTIONAL

837I Payloads

The agent constructs institutional claim files. This covers hospital and facility billing.

PAYER

Direct Transmission

The agent sends the finished EDI files to the payer. You don't have to manually upload anything.

HUMAN

Manual Review

You stay in control of the final data. The agent won't submit anything without your prompt or approval.

The workflow

What your AI does when you request a claim.

The agent takes your billing data and turns it into valid EDI files.

  1. Data Mapping

    Your agent takes your raw patient and provider info and maps it to the required EDI segments.

    opt_submit_professional_claimopt_submit_institutional_claim

  2. Professional Submission

    The agent generates the 837P file for professional services and sends it to the payer.

    opt_submit_professional_claim

  3. Institutional Submission

    The agent generates the 837I file for facility billing and handles the transmission.

    opt_submit_institutional_claim

  4. Transmission Confirmation

    The agent confirms the payload was successfully handed off to the payer's system.

    opt_submit_professional_claimopt_submit_institutional_claim

Try it

Copy these to start.

Use these prompts to trigger the submission tools.

Starting points

Replace the bracketed info with your actual patient or provider details.

Optum Claims Connector

You're all set. Choose your MCP client and follow the setup instructions.

Connector linkhttps://edge.vinkius.com/vk_preview_e4xPqwMzSwiBQ7KWDfZCZMaVrl034AScFZetyfpc/mcp

Claude Desktop

Follow the steps below to connect in seconds.

  1. 1In Claude Desktop, open Settings → Connectors.
  2. 2Click “Add custom connector” and paste the connector link above as the remote MCP server URL.
  3. 3Click Add and start a new chat — Optum Claims capabilities are ready to use.
Configuration · claude_desktop_config.jsonCopy
{
  "mcpServers": {
    "optum-claims-billing-mcp": {
      "url": "https://edge.vinkius.com/vk_preview_e4xPqwMzSwiBQ7KWDfZCZMaVrl034AScFZetyfpc/mcp"
    }
  }
}
Copy into chat04

  • Submit a professional 837P claim for patient John Doe using the data in my spreadsheet.

  • Generate and send an 837I institutional claim for the recent hospital stay at Mercy General.

  • Use the Optum tool to transmit a professional claim for the provider ID 99887.

  • Check if I can submit an 837P claim using the billing info from my recent CSV export.

  • Claude
  • ChatGPT
  • Cursor
  • VS Code
  • Windsurf
  • Claude Code
  • JetBrains
  • Cline

Start here

Connect Optum Claims & Billing once, then ask.

Just click the link to connect. Your credentials stay encrypted, and you can start using the tools in your preferred AI client immediately.

Connect Optum Claims & Billing to your AI

FAQ

How this task behaves.

  • 01

    Can the AI submit claims automatically without me?

    No. The agent only acts when you give it a specific instruction or prompt to do so.

  • 02

    Does the AI edit my original billing records?

    No. The agent reads your data to build the EDI payload, but it does not modify your source files or databases.

  • 03

    What kind of EDI files can it create?

    It can create 837P for professional claims and 837I for institutional claims.

  • 04

    Can the AI fix errors in my patient data?

    No. The agent uses the data you provide. If the data is incorrect, the claim will likely be rejected by the payer.

  • 05

    How do I know if the claim actually went through?

    The agent will confirm once the tool has successfully transmitted the payload to the payer.

  • More questions about Optum Claims & Billing? The Connector page answers them. See everything the Optum Claims & Billing Connector can do

Connect Optum Claims to Claude, Cursor, ChatGPT & more