Optum Claims & Billing MCP. Automate claim submission, tracking, and payment reconciliation.
Optum Claims & Billing MCP connects your AI agent directly to Optum's financial APIs. Submit professional and institutional medical bills, track their status immediately, download detailed payment remittances, and automatically resubmit corrections for denied claims. This tool handles the entire revenue cycle back-office process.
Claude 
ChatGPT 
Cursor 
Gemini 
Windsurf 
VS Code 
JetBrains 
Vercel Give Claude and any AI agent real-world access
Send professional (outpatient) and institutional (hospital stay) medical claims directly to the payer for payment processing.
Check the real-time status of any submitted claim, knowing immediately if it's approved, denied, or still under review.
Retrieve detailed Electronic Remittance Advice (ERA 835) files that break down exactly how much money was paid and why.
Automatically fix coding or administrative errors on a rejected claim and resend the corrected version to overturn the denial.
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What AI agents can do with Optum Claims & Billing: 5 Tools
These tools allow you to manage the entire financial lifecycle of medical billing—from initial submission through final payment reconciliation.
Make your AI actually useful.
Add this MCP to Claude, Cursor, or Windsurf and your AI stops guessing. It gets real tools to look things up, take action, and handle the stuff you keep doing by hand.
Start using Optum Claims & Billing MCPOpt Check Claim Status
Checks the current status of a medical bill, telling you if it's pending, denied, or paid.
Opt Get Remittance Advice
Downloads payment records (ERA 835) that detail exactly how much money was received...
Opt Handle Denial Revision
Fixes coding errors on a rejected claim and resubmits the corrected version to...
Opt Submit Institutional Claim
Submits large medical bills (837I) associated with hospital stays or major facility...
Opt Submit Professional Claim
Sends professional medical claims (837P) for outpatient visits and services provided...
Security and governance baked right in.
Pick your AI client below to get set up. Just create a Vinkius account, subscribe, and you're instantly up and running. We handle the entire backend infrastructure, delivering out-of-the-box support for HTTPS Streamable, SSE, and OAuth2—zero messy routing required.
Claude AI
Open Claude Settings
Go to claude.ai, click your profile icon, then navigate to Customize → Connectors.
Add Custom Connector
Click the "+" button and select Add custom connector. Paste your Vinkius endpoint URL:
https://edge.vinkius.com/[YOUR_TOKEN_HERE]/mcp
Replace [YOUR_TOKEN_HERE] with your token
from cloud.vinkius.com. For OAuth-protected servers, expand
Advanced settings to add credentials.
Start a conversation
Open a new chat. The Optum Claims & Billing integration is available immediately — no restart needed.
Choose How to Get Started
Build a custom MCP for your own tools, or connect a ready-made integration from our catalog.
Build Your Own
Turn any API into an MCP. Import a spec, define Agent Skills, or deploy with MCPFusion.
- Import from OpenAPI, Swagger, or YAML specs
- Create Agent Skills with progressive disclosure
- Deploy to edge with MCPFusion framework
- Built in DLP, auth, and compliance on each call
- Real time usage dashboard and cost metering
- Publish to catalog or keep private
Make Your AI Do More
Start with Optum Claims & Billing, then connect any of our 5,200+ other servers whenever your AI needs more. One click, no limits.
- Use this MCP plus 5,200+ others, all in one place
- Add new capabilities to your AI anytime you want
- Connections are secured and governed automatically
- Track usage and costs across all your servers
- Works with Claude, ChatGPT, Cursor, and more
- New servers added to the catalog weekly
Independent Platform Disclaimer: Vinkius is an independent platform and is not affiliated with, endorsed by, sponsored by, verified by, or otherwise authorized by Optum Claims. All third-party trademarks, logos, and brand names are the property of their respective owners. Their use on this website is strictly for informational purposes to identify service compatibility and interoperability.
VINKIUS CLOUD
Cloud Hosted
Managed infra
V8 Isolated
Sandboxed per request
Zero-Trust Proxy
No stored credentials
DLP Enforced
Policy on each call
GDPR Compliant
EU data residency
Token Compression
~60% cost reduction
The mess of manual medical billing reconciliation
Today, processing payments from insurance payers is slow and painful. You're stuck opening payer portals, downloading PDF remittance statements, logging into accounting software to cross-reference amounts, and then manually copy-pasting service codes and dollar totals into your general ledger. It’s a cycle of clicks, downloads, and inevitable data entry errors.
With this MCP, that whole process collapses. Your agent pulls structured payment records using opt_get_remittance_advice. You get clean, machine-readable payment breakouts instantly, letting you spend time analyzing cash flow instead of fighting with spreadsheets.
Getting final status and correcting denials
The biggest time sink is the denial process. When a claim doesn't pay, manually figuring out if it was a coding error or a policy issue, fixing the payload, and resubmitting it takes days of coordination across different departments.
Now, you use opt_handle_denial_revision. You fix the mistake within the agent environment, and the MCP handles the resubmission to Optum’s system automatically. The claim moves from 'Denied' directly toward 'Approved'.
What Optum Claims & Billing MCP does for your AI
Processing medical payments shouldn't involve mountains of paper or endless manual reconciliation. This MCP gives your AI client direct access to Optum’s core APIs, letting you take control of your billing lifecycle. You can construct and send complex claims—whether it's a doctor's office visit (professional) or a major hospital stay (institutional).
Need to know if that claim went through? Check the status instantly to see if it's approved, pending review, or rejected. When payments land in the bank, you don’t have to manually download statements; this MCP pulls down structured Electronic Remittance Advice records for easy reconciliation. If a payer denies a bill due to coding errors, you can even use the agent to fix and resubmit the corrected claim automatically.
Vinkius hosts this critical connector so your AI client can manage all these complex financial actions without needing specialized software or manual intervention.
019d75eb-4c85-7048-8ac4-fc00e3bfb3d2 
How to set up Optum Claims & Billing MCP
The bottom line is that you get automated access to Optum’s entire claims processing workflow without ever touching a manual form or waiting on batch file uploads.
First, you insert your financial client ID into the runtime module. This securely authorizes your agent's ability to send or receive sensitive billing data.
Next, you tell your AI client what needs doing—for example, submitting an institutional claim or fetching recent remittance advice.
The MCP executes the API call, returns a structured result (like the final status code or a payment payload), and feeds it back to your agent for action.
Who uses Optum Claims & Billing MCP
Billing Managers, Revenue Cycle Analysts, and FinTech Operations teams need this. If your job involves tracking payments from insurance payers, managing claim denials, or reconciling complex financial data streams, you'll use this. It takes the guesswork out of multi-stage payment cycles.
Uses this to monitor a backlog of claims by using opt_check_claim_status and coordinating resubmissions via opt_handle_denial_revision.
Relies on the MCP to pull bulk payment data using opt_get_remittance_advice, ensuring all incoming funds are correctly posted against outstanding bills.
Integrates claim submission processes by running scripts that call both opt_submit_professional_claim and opt_submit_institutional_claim for mass processing.
Benefits of connecting Optum Claims & Billing MCP
Stop manually chasing payments. You can use opt_get_remittance_advice to pull detailed ERA 835 records instantly, giving you a complete financial picture of every incoming check.
Speed up the entire billing cycle. Instead of waiting for human review, your agent submits claims using opt_submit_professional_claim or opt_submit_institutional_claim and tracks them with opt_check_claim_status.
Eliminate denial bottlenecks. When a claim gets rejected due to coding errors, you don't have to start over. You just use opt_handle_denial_revision to fix the issue and resubmit it right away.
Gain comprehensive oversight. Your AI client can manage both the initial submission of bills and the final reconciliation of funds in one workflow, linking payments directly back to submitted claims.
Maintain compliance and security. This MCP is built specifically for hospital back-office finance, isolating billing data from general patient records.
Optum Claims & Billing MCP use cases
Reconciling a large payment batch
A Billing Analyst needs to know what payments arrived last week. They ask their agent to use opt_get_remittance_advice, and the MCP pulls three detailed ERA 835 files, showing every dollar amount and which specific services they cover.
Following up on a denied claim
A Billing Manager finds out that a hospital stay was billed incorrectly. They instruct their agent to use opt_handle_denial_revision, fixing the coding errors in minutes and resubmitting the corrected 837I payload.
Submitting routine doctor visits
An office administrator needs to process fifty daily appointments. They ask their agent to use opt_submit_professional_claim, batch-submitting all the necessary professional bills (837P) in one secure operation.
Verifying pending claim status
A user needs to know if a major surgical bill is approved. They query their agent using opt_check_claim_status and get an immediate response: 'Approved, check date May 15th.'
Optum Claims & Billing MCP tradeoffs
What to watch out for, and the recommended way to handle each one.
Searching for payment records in PDF statements
Spending hours opening hundreds of PDFs from the bank or payer portal just to manually copy dollar amounts and service codes into a spreadsheet.
Use opt_get_remittance_advice. This tool downloads structured ERA 835 data, giving you clean, machine-readable payment breakouts immediately.
Starting the billing process from scratch
A claim was rejected last month because of a minor coding mistake, and now the user has to rebuild the entire submission payload manually.
Use opt_handle_denial_revision. This tool takes the original claim details, fixes the errors, and resubmits it for you, saving hours of reconstruction.
Guessing if a claim was processed
A manager wonders if the payer even saw that bill yet, forcing them to call the payer and wait on hold.
Use opt_check_claim_status. This gives you instant confirmation—approved, denied, or pending—so you know exactly where your time needs to go.
When to use Optum Claims & Billing MCP
You need this MCP if your core job revolves around the full financial lifecycle of medical claims: submission, tracking, payment, and dispute resolution. Use it when you need to move data across systems—for example, taking a claim status check (opt_check_claim_status) and then using that outcome to trigger a corrected resubmission (opt_handle_denial_revision). Don't use this if you just need to read a single PDF payment statement. For simple document retrieval or data visualization, a basic file-read tool is enough. If your goal is only to write a claim payload without confirming its status or receiving payment advice, the MCP still manages that workflow but might be overkill.
Frequently asked questions about Optum Claims & Billing MCP
Does Optum Claims & Billing help with both hospital and office visits? +
Yes, it handles both major facility payments (institutional) using opt_submit_institutional_claim and smaller doctor/outpatient services (professional) via opt_submit_professional_claim.
How can I check the status of a bill submitted through Optum Claims & Billing? +
You use the opt_check_claim_status tool. This gives you an immediate, definitive answer on whether your medical claim is approved, denied, or still pending review.
What kind of data does opt_get_remittance_advice provide? +
This tool downloads the ERA 835. It provides a detailed breakdown of payments, showing exactly which payer paid how much and for what specific services rendered.
Is this MCP secure enough for handling financial data? +
Yes. The architecture is engineered specifically to handle back-office finances, ensuring high security and compliance by keeping billing functions separate from general patient records.
Can I use Optum Claims & Billing to fix a rejected claim? +
Absolutely. You use opt_handle_denial_revision. This process allows you to correct coding errors and resubmit the necessary documentation to overturn a payer denial.