Introduction - Healthcare APIs

Availity web service APIs are designed using a RESTful approach. Our REST API offers predictable, resource-oriented URLs and uses HTTP response codes to indicate API success and failure conditions. Availity REST APIs all return JSON and XML representations, including errors. Some API's have the ability to return CSV, PDF, PNG, and XLS representations.

We offer a trial package that allows you to begin exploring our APIs without completing a formal application process. Using demo data (without PHI information), you'll get up-to-speed quickly, and at no cost to you.

cURL SAMPLES

We use cURL for all samples in this guide so that you can try them. You can download cURL software if needed. Be sure to include your API key and specific IDs for calls.

Important: The sample requests in this guide are examples only and not runnable as is. Substitute all call-specific parameters (such as API Keys, access tokens, and IDs) with your own values.

 

Get an API Key

All requests to the Availity REST APIs must be authenticated with an Client ID (API Key) including demo endpoints.

GET AN ACCOUNT

1. Sign up at Register. Enter the required information and click Create New Account at the bottom of the page.
2. Logon to the Availity Developer Portal, using the email address and password from the previous step.

REGISTER AN APPLICATION

1. Once logged in successfully, click Apps in the top menu.
2. You will need to create separate applications for the Demo plan, and the Standard rate plan. You will select your plan under the "Select a Plan" below.
3. Take note of your Client Secret right away. You will not see it again.

SELECT A PLAN

1. See API Products in top menu.
2. Drill down to view specific details about API Product.
3. Select Demo Rate Plan for Mock data response and Standard Rate plan for Live data response.
4. Click Subscribe to the plan you are interested in and select the appropriate application which you registered previously.

APPROVALS

Demo plans subscribed to an application will automatically be approved for use right away. All other plans will require verification, contracting and approval. A notification will automatically be sent to Availity API Support to process.

Cross-Site Scripting Prevention

One of the most commonly exploited web security vulnerabilities is called Cross Site Scripting (XSS). Simply put, this type of attack tricks a company into serving malicious JavaScript to users' browsers. This is possible because browsers do not distinguish between text to show the user and scripts to execute.

There are three main categories of XSS attacks:

1. Reflected XSS - When an XSS attack is "reflected" off of the web service and returned back to an end user, this is a Reflected XSS Attack. A common form of this is an error message. For example, if an attacker enters into a zip code URL parameter: &zipcode=20879<script>alert('Gotcha')</script> the web service code may check that it's a valid zip code, yet not output encode and sanitize it. The web service may respond with an error message saying: 20878<script>alert('Gotcha')</script> is not a valid Zip Code If this happens the attacker will now have full access control to that user's browser.
2. Stored XSS - If the XSS is stored "permanently" on a target server this is a Stored XSS Attack. Classic examples of this would be comments in WordPress, forum posts, and contact forms.
3. DOM XSS - This is the newest form of XSS and is when the "attacker's payload" is injected directly into the browser DOM creating a DOM XSS Attack. An example would be if such JavaScript code exists: var message = document.cookie; document.errorDiv.innerHTML = message This would expose the cookie value to an HTML section of the current page.

To learn more about Cross-Site Scripting visit the Open Web Application Security Project (OWASP) website, which has listed XSS Attacks as the #3 most critical security flaw that can exist in applications today. OWASP Top 10 2013-A3 Cross Site Scripting (XSS)

How Availity APIS help you prevent XSS Attacks

Availity continually works to keep your data and our data as secure as possible. We support two parts that will to help prevent XSS attacks:

1. Input validation and sanitization.
2. Encode resources specifically for their intended use context.

Input Validation and Sanitization

We have implemented whitelist rules for data validation that have been carefully designed to provide protection even against future vulnerabilities introduced by browser changes. What this means for you as a developer is, if you send a request to an API that contains characters which we've determined to not be safe, an HTTP 400 response is returned with an inbound injection error message. You are required to fix the data and re-submit your request. The best way for you to avoid receiving this error is to ensure that you use proper input validation and sanitization on your side before calling an API.

Response Resource Encoding

Encoding is a complicated process because there are different encoders for each given context. An HTML Body string encode isn't the same as a JavaScript string encode. This is where problems can arise as the attacks also vary from context to context. If encoding isn't done properly for the context you're displaying the data in, an attack can slip through.

By default, we do not provide response resource encoding for an API. If you wish to take advantage of encoding you must opt-in to it by sending an X-Response-Encoding-Context request header with one of the following values:

• HTML - Performs encoding of data for use in HTML entities.
• HTML_ATTRIBUTE - Performs encoding of data for use in HTML attributes values.
• CSS - Performs encoding of data for use in stylesheets and style tags.
• URL - Performs encoding of data for use in a URL.
• JAVA_SCRIPT - Performs encoding of data for use in JavaScript data values.
• XML - Performs encoding of data for use in XML entities.
• XML_ATTRIBUTE - Performs encoding of data for use in XML attribute values.

We highly recommend that you use the appropriate response encoding context when using our API if you will be displaying API resources directly in your application.

Encoding Examples

Below is an example request to the Configurations service showing a partial resource that was returned using the HTML encoding context.

Notice the providerNpi.errorMessage object, the message contents that contained () characters is escaped for use in HTML.

	curl -X "GET" "https://api.availity.com/availity/v1/configurations?type=270&payerId=700" -H "Authorization: Bearer abc12345" -H "X-Response-Encoding-Context : HTML"

configurations[0].providerNpi.errorMessage = "Enter a valid National Provider Identifier (NPI) containing 10 numeric digits and beginning with a 1, 2, 3, or 4."

Authentication

All Availity REST API's support OAuth2 over HTTPS for authentication including requests to Demo resources.

You may have multiple Client IDs active at one time. Your Client ID carry many privileges, so be sure to keep them secret. If you want to make a REST API request to Availity we will assume that you have already:

1. Signed up for an account on the Availity developer portal.
2. Obtained an Client ID for your application.

OAuth2

The Availity REST API supports the Application-only authentication method, which is based on the Client Credentials Grant flow of the OAuth 2.0 spec.

There are 2 steps required to make an initial API request. The following is an example for obtaining an access token and making a request to the Coverages resource:

1. Get an OAuth2 Access Token

This will return a response that contains an access token, token type, and expiration time. The access token is only valid for 5 minutes.

	curl -i -X "POST" "https://api.availity.com/availity/v1/token" \
	  -d "grant_type=client_credentials&client_id=$CLIENT_ID&client_secret=$CLIENT_SECRET&scope=hipaa"
	
	->
	HTTP/1.1 200 OK
	Connection: Keep-Alive
	Transfer-Encoding: chunked
	Content-Type: application/json
	Cache-Control: private, no-store, no-cache, must-revalidate
	Pragma: no-cache
	
	{ "token_type":"bearer", "access_token":"AAEkZGI1ZjRhYzgtYWViNy00NmRmLWE0YjYtND5NTliZDI0NTc2kPwma8ezU6mkghUoomSLMUbB8LMPc4NJFNkEyrrmFMZabZ67DHXL3gaCr01_mln8-qLDQWne-8stwXOpb2dObXP3SAt8yn1LDQehlNw_KTcZf1H1-FyAFyM5Nh4g0zNs9ATtj2l-H98FzXl9MoBA", "expires_in":300, "scope":"hipaa" }

The request body parameters are case sensitive. Make sure grant_type=client_credentials matches exactly how it is shown.

2. Call REST API with OAuth2 Access Token

We use the access token from step #1 and make requests to the Availity REST API's. The example below shows making a request to the Coverages API. This includes the Availity demo endpoints as well.

	curl -i -H "Authorization: Bearer $ACCESS_TOKEN" -X "GET" "https://api.availity.com/availity/v1/coverages?payerId=BCBSF" \
	

Making Your First Call

With your applications Client ID available, you're now ready to make a request to a REST resource. Below is an example of a request to retrieve a collection of coverages.

The API Key is case sensitive.

	 curl -i -H "Authorization: Bearer $ACCESS_TOKEN" -X GET "https://api.availity.com/availity/v1/coverages" 
	->
	{
	  "totalCount": 5,
	  "count": 5,
	  "offset": 0,
	  "limit": 50,
	  "links": {
		"self": {
		  "href": "https://api.availity.com/availity/v1/coverages"
		}
	  },
	  "coverages": [
		{
		  "links": {
			"self": {
			  "href": "https://api.availity.com/availity/v1/coverages/0001234821666577173234942038175340242587013739108497709963594997"
			}
		  },
		  "id": "0001234821666577173234942038175340242587013739108497709963594997",
		  "customerId": "4321",
		  "controlNumber": "9876543",
		  "status": "Complete",
		  "statusCode": "4",
		  "createdDate": "2017-06-15T16:31:07.000+0000",
		  "updatedDate": "2017-06-15T16:31:07.000+0000",
		  "expirationDate": "2017-06-16T16:31:07.000+0000",
		  "asOfDate": "2017-06-15T04:00:00.000+0000",
		  "requestedServiceType": [
			{
			  "code": "30",
			  "value": "Health Benefit Plan Coverage"
			}
		  ],
		  "subscriber": {
			"firstName": "ZENA",
			"lastName": "MARDIN",
			"memberId": "H87654321",
			"gender": "Female",
			"genderCode": "F",
			"birthDate": "1942-09-15T04:00:00.000+0000"
		  },
		  "patient": {
			"firstName": "ZENA",
			"lastName": "MARDIN",
			"subscriberRelationship": "Self",
			"subscriberRelationshipCode": "18",
			"gender": "Female",
			"genderCode": "F",
			"birthDate": "1942-09-15T04:00:00.000+0000"
		  },
		  "payer": {
			"name": "HUMANA",
			"payerId": "HUMANA"
		  },
		  "requestingProvider": {
			"npi": "1234567893",
			"taxId": "123123123"
		  },
		  "plans": [
			{
			  "status": "Active Coverage",
			  "statusCode": "1",
			  "groupNumber": "P1234567"
			}
		  ]
		}
	  ]
	}

Demo Endpoints

Availity has created demo (mock response) versions of each endpoint that you can explore. Each has a number of demo responses available. You can choose which demo response you want by sending a header with your request. The name of the header is X-Api-Mock-Scenario-ID and the value is the id of the response scenario you want. For demo response confirmation, inspect response header for X-Api-Mock-Response: true. You can find supported response scenarios in the documentation of each endpoint.

	$ curl -i -H "Authorization: Bearer $ACCESS_TOKEN" " -H "X-Api-Mock-Scenario-ID: Demo-Example1" -X GET "https://api.availity.com/availity/v1/coverages"
	->
	HTTP/1.1 200 OK
	Connection: Keep-Alive
	Transfer-Encoding: chunked
	Content-Type: application/json
	Date: Mon, 10 Jul 2017 13:56:47 GMT
	X-Global-Transaction-ID: 2032325519
	Cache-Control: private,no-store,max-age=0,must-revalidate
	x-api-id: 1599f0e1-36a3-43de-a937-d2770beb6625
	X-Api-Mock-Response: true
	X-Session-ID: 1599f0e1-36a3-43de-a937-d2770beb6625
	X-planid: healthcare-hipaa-transactions:1.0.0:demo
	X-planname: demo
	
	{
	  "message": "This is an example."
	}

HTTP Status Codes

CODE	STATUS	VERB	DESCRIPTION
200	OK	GET, PUT	Successfully retrieved or updated an existing resource.
200	OK	GET by ID	Operation was successful and returns 0 or more resources. The metadata count property in the response body contains the number of resources returned.
200	OK	PATCH	Successfully updated field(s) in an existing resource.
201	Created	POST	Successfully created a new resource
202	Accepted	GET, POST, PUT, DELETE, PATCH	The request has been accepted for processing, but the processing has not been completed. The Location header contains the URI to monitor for status updates.
204	No Content	DELETE	The service fulfilled the request, which may have removed a resource from server cache, server DB or external resource. The API client can consider the resource no longer available.
303	See Other	GET	The response to the request can be found under a different URI provided in the Location header and should be retrieved using a GET method on the URI.
400	Bad Request	GET by ID	The request could not be understood by the service due to malformed query parameters.
400	Bad Request	POST	The request could not be understood by the service due to malformed syntax.
400	Bad Request	PUT	The request could not be understood by the service due to malformed syntax.
401	Unauthorized	GET, POST, PUT, DELETE, PATCH	The API client is not authorized to make this request. The request requires user authentication.
403	Forbidden	GET, POST, PUT, DELETE, PATCH	The server understood the request, but is refusing to fulfill it. This may be temporary or permanent, depending on the use case.
404	Not Found	GET, PUT, DELETE, PATCH	The service has not found anything matching the Request URI. No indication is given whether the condition is temporary or permanent.
405	Method Not Found	GET, POST, PUT, PATCH, DELETE	The method specified in the Request-Line is not allowed for the resource identified by the Request-URI.
406	Not Acceptable	GET, POST, PUT, DELETE, PATCH	The resource identified by the request is only capable of generating response entities that have content characteristics not acceptable according to the Accept headers sent in the request.
409	Conflict	POST, PUT, PATCH, DELETE	The service could not complete the request due to a conflict with the current state of the resource.
410	Gone	GET, PUT, DELETE, PATCH	The requested resource is no longer available and there is no forwarding URI known, this condition is permanent and you should not request the resource again in the future.
415	Unsupported Media Type	GET, POST, PUT, DELETE, PATCH	The server is refusing to service the request because the entity of the request is in a format not supported by the requested resource for the requested method.
422	Unprocessable Entity	POST, PUT, PATCH, DELETE	The JSON/XML request entity is properly formed and the media type is a supported media type for the resource; but validation has failed or the request entity is a different type or version than the service supports
500	Internal Server Error	GET, POST, PUT, DELETE, PATCH	The service encountered an unexpected condition that prevented it from fulfilling the request.

Collections

A Collection Resource is a resource containing other resources. It is known as a Collection Resource because it is itself a first class resource, it has its own attributes similar to any other resource in addition to the instances it contains.

If you want to interact with multiple resources, you must do so with a Collection Resource. They support additional behavior specific to collections, such as pagination, sorting, and searching.

Collection Resource Attributes

ATTRIBUTE	DESCRIPTION	MIN	MAX	DEFAULT	TYPE
links	Set of resource URI's	-	-	-	Object
offset	The zero-based starting index in the collection of the first item to return	0	-	0	Integer
limit	The maximum number of collection items to return for a single request	1	50	50	Integer
count	The number of items returned	0	-	-	Integer
totalCount	The total number of items available that match the parameters specified	0	-	-	Integer
resources	An array containing the current page of resources, the attribute name will be the plural name of the resource type, such as coverages. The size of the array can be less than the requested limit. For example, if the limit requested is greater than the maximum allowed or if the response returned less than the limit amount.	0	-	-	Array

Pagination

If a Collection Resource contains a large number of resource instances, it will not include all of them in a single response. Instead, pagination is used to break up the results into one or more pages of data. You can request additional pages as separate requests.

Example Collection Resource Partial Response

	{
	  "totalCount": 19,
	  "count": 5,
	  "offset": 0,
	  "limit": 5,
	  "links": {
		"last": {
		  "href": "https://api.availity.com/availity/v1/coverages?limit=5&offset=14"
		},
		"next": {
		  "href": "https://api.availity.com/availity/v1/coverages?limit=5&offset=5"
		},
		"self": {
		  "href": "https://api.availity.com/availity/v1/coverages?limit=5"
		}
	  },
	  "coverages": [
		{
		  "customerId": "1194",
		  "batchId": "14029438773180168889579000001660",
		  "controlNumber": "1-1020",
		  "status": "Communication Error",
		  "statusCode": "14",
		  "createdDate": "2017-07-16T18:38:12.000+0000",
		  "updatedDate": "2017-07-16T18:38:12.000+0000",
		  "expirationDate": "2017-07-16T19:07:23.000+0000",
		  "asOfDate": "2017-02-03T05:00:00.000+0000"
		},
		{
			...
		}
	  ]
	}

Query Parameters

The Availity API utilizes cursor-based pagination using two optional query parameters, if they aren't specified the default values are used:

offset The zero-based starting index in the collection of the first item to return. Default is 0.

limit The maximum number of collection items to return for a single request. Minimum value is 1, Maximum value is 50.

Link Relations

The links attribute will contain Link Relations depending on which page and the number of resources returned. If a Link Relation is not available you will receive a null value when trying to access it.

LINK RELATION	PURPOSE	HREF
self	The URL used to retrieve the Collection Resources	"https://api.availity.com/availity/v1/coverages?offset=50&limit=50"
first	The URL to retrieve the first page of resources	"https://api.availity.com/availity/v1/coverages?offset=0&limit=50"
last	The URL to retrieve the last page of resources	"https://api.availity.com/availity/v1/coverages?offset=251&limit=50"
next	The URL to retrieve the next page of resources	"https://api.availity.com/availity/v1/coverages?offset=100&limit=50"
prev	The URL to retrieve the previous page of resources	"https://api.availity.com/availity/v1/coverages?offset=0&limit=50

Date Time Format

All date and time values used in the Availity API use the ISO 8601 format.

Example

	"createdDate": "2014-06-16T18:38:12.000+0000"

Errors

REST API responses indicating an error or warning will return a response body with extended error information. Conventional HTTP status codes are used to indicate success or failure of an API request. In general, codes in the 2xx range indicate success; codes in the 4xx range could indicate missing required parameters or authentication/authorization failures; and codes in the 5xx range indicate an error within Availity's or downstream servers.

Example Error Response

	{
		"statusCode": 404,
		"userMessage": "The coverage you specified cannot be found.",
		"developerMessage": "The specified coverage cannot be found. 
		  If you accessed this url via a stale href reference,
		  it's possible the coverage object has expired in our 
		  system, you should acquire the members Coverage Collection 
		  Resource again to obtain the current list of coverages.",
		"url": "https://api.availity.com/availity/v1/documentation/coverages",
		"errors": [
			{
				"code": 545,
				"errorMessage": "Some other extended error occurred"
			},
			{
				"code": 615,
				"errorMessage": "Some other extended error occurred"
			}
		]
	}

Error Response Attributes

Attribute	Description	Type
statusCode	The HTTP status code	Integer
reasonCode	Internal error code (currently not used)	Integer
userMessage	Error message appropriate for display to end user	String
developerMessage	A more detailed error message appropriate for a developer	String
url	URL where more information can be found on the error	String
errors	A collection of extended error messages if available	Array
errors.code	Service-specific error code	Integer
errors.errorMessage	Service-specific error message for error code	String

Coverages

This resource allows you to find and manage a member's coverage information.

Working with the DEMO endpoints

Availity allows you to specify the type of response you want when interacting with our Coverages demonstration service by sending a header (X-Api-Mock-Scenario-ID) with the appropriate response scenario id. The supported response scenarios are listed below.

Response Scenario ID	Status Code	Description
Coverages-Complete-i	200	Availity has successfully retrieved the member's coverage information from the health plan.
Coverages-PayerError1-i	200	The health plan has indicated that the provider is ineligible for inquiries.
Coverages-PayerError2-i	200	The health plan has indicated that the subscriber name is invalid.
Coverages-InProgress-i	202	Availity is in the process of retrieving the member's coverage information from the health plan.
Coverages-Retrying-i	202	The health plan did not respond so Availity is retrying the request.
Coverages-RequestError1-i	400	Your request failed Availity's input validation rules.
Coverages-RequestError2-i	400	Your request failed Availity's input validation rules.

Payer can return the following errors:

Code	Description
04	Authorized Quantity Exceeded
15	Required Application Data Missing
33	Input Errors
35	Out of Network
41	Authorization/Access Restrictions
42	Unable to Respond at Current Time
43	Invalid/Missing Provider Identification
44	Invalid/Missing Provider Name
45	Invalid/Missing Provider Specialty
46	Invalid/Missing Provider Phone Number
47	Invalid/Missing Provider State
48	Invalid/Missing Referring Provider Identification Number
49	Provider is Not Primary Care Physician
50	Provider Ineligible for Inquiries
51	Provider Not on File
52	Service Dates Not Within Provider Plan Enrollment
53	Inquired Benefit Inconsistent with Provider Type
54	Inappropriate Product/Service ID Qualifier
55	Inappropriate Product/Service ID
56	Inappropriate Date
57	Invalid/Missing Date(s) of Service
58	Invalid/Missing Date-of-Birth
60	Date of Birth Follows Date(s) of Service
61	Date of Death Precedes Date(s) of Service
62	Date of Service Not Within Allowable Inquiry Period
63	Date of Service in Future
64	Invalid/Missing Patient ID
65	Invalid/Missing Patient Name
66	Invalid/Missing Patient Gender Code
67	Patient Not Found
68	Duplicate Patient ID Number
69	Inconsistent with Patient's Age
70	Inconsistent with Patient's Gender
71	Patient Birth Date Does Not Match That for the Patient on the Database
72	Invalid/Missing Subscriber/Insured ID
73	Invalid/Missing Subscriber/Insured Name
74	Invalid/Missing Subscriber/Insured Gender Code
75	Subscriber/Insured Not Found
76	Duplicate Subscriber/Insured ID Number
77	Subscriber Found, Patient Not Found
78	Subscriber/Insured Not in Group/Plan Identified
79	Invalid Participant Identification
80	No Response received - Transaction Terminated
97	Invalid or Missing Provider Address
98	Experimental service or procedure
AA	Authorization number not found
AE	Requires primary care physician authorization
AF	Invalid/missing diagnosis code(s)
AG	Invalid/missing procedure code(s)
AO	Additional patient coordination information required
CI	Certification information does not match patient
E8	Requires medical review
IA	Invalid authorization number format
MA	Missing authorization number
T4	Payer Name or Identifier Missing

GET /V1/COVERAGES

You can retrieve a snapshot of a member's health plan coverage by querying the coverages resource with the following parameters:

Parameter	Required	Type	Description
payerId	No	String	This is the Availity id of the health plan that the member has coverage with. You can view the list of payer id's by selecting the Coverage Resource from the Supported Health Plans link on the contents menu on the left side of this page.
providerType	No	String	Certain health plans require that the submitter specify whether or not they are a professional or institutional provider. You can specify that using this optional field.
providerNpi	No	String	Most health plans require that you send the provider's National Provider Identifier number to identify who is requesting to see a member's coverage information. Specify this value using this parameter.
providerTaxId	No	String	Some health plans require that you send the provider's tax id. Please use this parameter to specify the requesting provider's tax id.
payerAssignedProviderId	No	String	A few health plans allow you to specify a payer-assigned identifier for the requesting provider. If the requesting provider has been assigned a payer-assigned provider id, send it using this parameter.
providerSSN	No	String	A few health plans allow you to specify a provider's SSN.
providerFirstName	No	String	The provider's first name.
providerLastName	No	String	The provider's last name.
providerCity	No	String	Certain health plans require that you specify the city that the provider is located in. You can send that information using this parameter.
providerState	No	String	Certain health plans require that you specify the state that the provider is located in. You can send that information using this parameter.
providerZipCode	No	String	Certain health plans require that you specify the ZIP code that the provider is located in. You can send that information using this parameter.
providerSpecialty	No	String	Certain health plans allow you to specify the provider's specialty using a taxonomy code.
placeOfService	No	String	Certain health plans require that you identify the place of service.
submitterId	No	String	Some health plans require that you identify yourself using a payer-assigned submitter identifier. Please send that information for health plans that require it using this parameter.
asOfDate	No	Date	You can indicate the date of service or point in time you want to check coverage information for using this parameter.
toDate	No	Date	Some health plans require that you provide an end date for your coverage information search period. If checking coverage for such a health plan, please use this parameter.
serviceType	No	String	You can specify the type or types of service using this parameter.
memberId	No	String	The patient's health plan member id.
medicaidId	No	String	The Medicaid id of the patient or subscriber.
patientSSN	No	String	The patient's SSN.
patientLastName	No	String	The patient's last name.
patientFirstName	No	String	The patient's first name.
patientMiddleName	No	String	The patient's middle name.
patientGender	No	String	The patient's gender.
patientBirthDate	No	Date	The patient's birth date.
patientSuffix	No	String	The patient's suffix.
patientState	No	String	The subscriber's patient of residence.
groupNumber	No	String	The patient's group number.
subscriberRelationship	No	String	If the patient is not the subscriber, you can specify their relationship to the subscriber using this parameter.
externalTraceId	No	String	If you would like to assign a trace id to one or more coverages, specify an externalTraceId. You will be able to filter your requests by this id when searching.
externalControlNumber	No	String	If you would like to assign a unique identifier to a particular coverage, specify an externalControlNumber. You will be able to filter your requests by this id when searching.
providerOfficeId	No	String	If you would like to tag one or more coverages with your own system's customer id, you can do so by sending this parameter.
providerUserId	No	String	If you would like to tag a coverage with your own system's user id, you can do so by sending this parameter.

Sample Requests

When you make a valid request, the resource will return a status code of 200 and a coverage summary.

Note: The response has been truncated to conserve space.

	$ curl -X GET "https://api.availity.com/availity/v1/coverages""
	->
	{
	  "totalCount": 5,
	  "count": 5,
	  "offset": 0,
	  "limit": 50,
	  "links": {
		"self": {
		  "href": "https://api.availity.com/availity/v1/coverages"
		}
	  },
	  "coverages": [
		{
		  "links": {
			"self": {
			  "href": "https://api.availity.com/availity/v1/coverages/0001234821666577173234942038175340242587013739108497709963594997"
			}
		  },
		  "id": "0001234821666577173234942038175340242587013739108497709963594997",
		  "customerId": "4321",
		  "controlNumber": "9876543",
		  "status": "Complete",
		  "statusCode": "4",
		  "createdDate": "2014-10-15T16:31:07.000+0000",
		  "updatedDate": "2014-10-15T16:31:07.000+0000",
		  "expirationDate": "2014-10-16T16:31:07.000+0000",
		  "asOfDate": "2014-10-15T04:00:00.000+0000",
		  "requestedServiceType": [
			{
			  "code": "30",
			  "value": "Health Benefit Plan Coverage"
			}
		  ],
		  "subscriber": {
			"firstName": "ZENA",
			"lastName": "MARDIN",
			"memberId": "H87654321",
			"gender": "Female",
			"genderCode": "F",
			"birthDate": "1942-09-15T04:00:00.000+0000"
		  },
		  "patient": {
			"firstName": "ZENA",
			"lastName": "MARDIN",
			"subscriberRelationship": "Self",
			"subscriberRelationshipCode": "18",
			"gender": "Female",
			"genderCode": "F",
			"birthDate": "1942-09-15T04:00:00.000+0000"
		  },
		  "payer": {
			"name": "HUMANA",
			"payerId": "HUMANA"
		  },
		  "requestingProvider": {
			"npi": "1234567893",
			"taxId": "123123123"
		  },
		  "plans": [
			{
			  "status": "Active Coverage",
			  "statusCode": "1",
			  "groupNumber": "P1234567"
			}
		  ]
		}
	  ]
	}

This coverage summary contains high level information about the coverage.

Availity stores short-lived, local copies of each coverage (until the time specified by the expirationDate property). If we do not have a recent local copy of a particular coverage, we will request it from the health plan. This is an asynchronous process. You can track the current status using the status and statusCode properties of the coverage.

To search your recently requested coverages, in addition to the parameters above, you can also use the following parameters:

Parameter	Required	Type	Description
status	No	String	Search for coverages with a status of "In Progress", "Request Error", "Communication Error", or "Complete".
planStatus	No	String	Search for coverages with a plan status of "Active" or "Inactive"
q	Yes	String	Search for coverages that match free form search terms.
sortBy	No	String	Sort the results by "lastUpdateDate", "asOfdate", or "patientLastName". The default is "lastUpdateDate".
sortDirection	No	String	Sort the results in "asc" or "desc" order. The default is "desc".

Important: When performing a search query, you must specify the q parameter. If you do not require a free-form matching of terms you may leave it empty, q=

If you send invalid parameters, the resource will return a status code of 400 and an error response:

	$ curl -X GET "https://api.availity.com/availity/v1/coverages?payerId=BCBSF"
	->
	{
		"userMessage": "This client system has made an invalid request.",
		"developerMessage": "Your request is not formed properly. Please check your request and the API documentation.",
		"documentation": "https://api.availity.com/availity/v1/documentation/coverages",
		"reasonCode": 0,
		"statusCode": 400,
		"errors": [
			{
				"field": "submitterId",
				"errorMessage": "Please enter a valid Submitter ID."
			},
			{
				"field": "serviceType",
				"errorMessage": "This field is required."
			},
			{
				"field": "patientBirthDate",
				"errorMessage": "Enter a valid date that is not in the future."
			},
			{
				"field": "memberId",
				"errorMessage": "Enter a patient ID containing letters, numbers, spaces, and any of the following special characters: ,;'-.?!&/\\#+=()"
			},
			{
				"field": "providerNpi",
				"errorMessage": "Enter a valid National Provider Identifier (NPI) containing 10 numeric digits and beginning with a 1, 2, 3, or 4."
			},
			{
				"field": "patientLastName",
				"errorMessage": "Enter a name containing letters, numbers, spaces, and any of the following special characters: ,;'-.?!&/\\#+=()"
			}
		]
	}

Hint: In general, sending as many fields as you can is a good approach. The rules vary according to the health plan and some have specific requirements. These rules are documented as a feature of our configurations resource.

If a coverage reports its statusCode and status properties as "0" and "In Progress" respectively, Availity is in the process of retrieving the coverage from the health plan. You should poll by either repeating your request or making a GET by id request periodically for the coverage until the statusCode and status properties change. "In Progress" coverages will include an etaDate property reporting the time we anticipate the refresh will be complete. The status property will change to one of several values:

Status Code	Status	Description
19	Request Error	Indicates that the health plan has returned one or more validationMessages.
R1	Communication Error, Retrying	Indicates that the health plan did not respond and we are retrying the request.
7	Communication Error	Indicates that the health plan did not respond.
13	Communication Error	Indicates that the health plan's response was invalid.
14	Communication Error	The health plan did not respond.
15	Communication Error	The health plan has indicated that they are down maintenance.
4	Complete	Indicates that the refresh was completed successfully.
3	Complete (Invalid Response)	Indicates that the refresh was completed successfully, but the health plan's response was partially invalid. Availity will still return all available information from the response, but some values may be missing.

When you make a search request, the resource will return a status code of 200 and the first page of matching coverage summaries:

	$ curl -X "GET" "https://api.availity.com/availity/v1/coverages?payerId=BCBSF&providerNpi=1234567893&memberId=PBHR123456&patientLastName=Parker&patientFirstName=Peter&serviceType=98&patientBirthDate=1990-01-01&providerTaxId=123456789"
	->
	{
	  "totalCount": 1,
	  "count": 1,
	  "offset": 0,
	  "limit": 50,
	  "links": {
		"self": {
		  "href": "https://api.availity.com/availity/v1/coverages?payerId=BCBSF&providerNpi=1234567893&memberId=PBHR123456&patientLastName=Parker&patientFirstName=Peter&serviceType=98&patientBirthDate=1990-01-01&providerTaxId=123456789"
		}
	  },
	  "coverages": [
		{
		  "links": {
			"self": {
			  "href": "https://api.availity.com/availity/v1/coverages/0001234457589486807542108543870042194372034683103803500071606998"
			}
		  },
		  "id": "0001234457589486807542108543870042194372034683103803500071606998",
		  "customerId": "1234",
		  "status": "In Progress",
		  "statusCode": "0",
		  "createdDate": "2014-10-15T15:33:29.000+0000",
		  "updatedDate": "2014-10-15T15:33:29.000+0000",
		  "expirationDate": "2014-10-16T15:33:28.000+0000",
		  "etaDate": "2014-10-15T15:33:29.000+0000",
		  "asOfDate": "2014-10-15T04:00:00.000+0000",
		  "requestedServiceType": [
			{
			  "code": "30",
			  "value": "Health Benefit Plan Coverage"
			}
		  ],
		  "subscriber": {
			"memberId": "111222333"
		  },
		  "patient": {
			"subscriberRelationship": "Self",
			"subscriberRelationshipCode": "18",
			"birthDate": "2001-01-10T05:00:00.000+0000"
		  },
		  "payer": {
			"name": "HUMANA",
			"payerId": "HUMANA"
		  },
		  "requestingProvider": {
			"taxId": "123123123"
		  }
		}
	  ]
	}

When you request one or more summaries by id, the resource will return a status code of 200 and any requested unexpired coverage summaries:

	$ curl -X GET "https://api.availity.com/availity/v1/coverages?id=0001194499098175762045868562105833796329766732695450956940743265&id=00011944990981757620458685621358337963297667326954509569407491523" 
	->
	{
		"coverages" : [
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/availity/v1/coverages/0001194499098175762045868562105833796329766732695450956940743265"
					}
				},
				"customerId": "1234",
				"requestedServiceType": [...],
				"subscriber": {...},
				"patient": {...},
				"payer": {...},
				"requestingProvider": {...},
				"plans": [...]
			},
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/availity/v1/coverages/00011944990981757620458685621358337963297667326954509569407491523"
					}
				},
				"customerId": "1234",
				"requestedServiceType": [...],
				"subscriber": {...},
				"patient": {...},
				"payer": {...},
				"requestingProvider": {...},
				"plans": [...]
			}
		]
	}

The coverage summary also contains demographics about the member, their overall plan status, and other information to help identify the coverage.

Availity will return the first 50 coverages that match your search. If there are more than 50 matching coverages, links to subsequent pages will be returned. For more information on paging of data, see pagination.

GET /V1/COVERAGES/:ID

You can retrieve the details about a member's coverage by requesting an individual coverage.

When you make a valid request, the resource will return a status code of 200 and a coverage:

	$ curl -X GET "https://api.availity.com/availity/v1/coverages/0001194499098175762045868562105833796329766732695450956940743265"
	->
	{
		"id": "0001194499098175762045868562105833796329766732695450956940743265",
		"customerId": "1234",
		"batchId": "14121823232660172516451000001173",
		"controlNumber": "23337",
		"externalTraceId" : "12314",
		"externalControlNumber": "1",
		"providerOfficeId": "Office246810",
		"providerUserId": "UserOffice246810",
		"status": "Complete",
		"statusCode": "4",
		"createdDate": "2017-10-01T16:52:06.000+0000",
		"updatedDate": "2017-10-01T16:52:06.000+0000",
		"expirationDate": "2017-10-31T16:52:05.000+0000",
		"etaDate" : "2017-10-01T16:52:06.000+0000",
		"asOfDate": "2017-09-30T04:00:00.000+0000",
		"toDate": "2017-09-30T04:00:00.000+0000",
		"requestedServiceType": [...],
		"validationMessages": [...],
		"subscriber": {...},
		"patient": {...},
		"payer": {...},
		"requestingProvider": {...},
		"plans": [...],
		"supplementalInformation": {...},
		"reminders" : {...},
		"links": {...}
	}

The subscriber object contains demographics about the health plan subscriber.

	"subscriber" : {
		"firstName" : "JAMES",
		"middleName" : "T",
		"lastName" : "KIRK",
		"suffix" : "SR",
		"memberId" : "ASDF12345",
		"gender" : "Male",
		"genderCode" : "M",
		"ssn" : "123591122",
		"birthDate" : "1982-04-28T00:00:00.000+0000",
		"address" : {
			"line1" : "123 MAIN ST",
			"line2" : "SUITE 1",
			"city" : "JACKSONVILLE",
			"state" : "Florida",
			"stateCode" : "FL",
			"zipCode" : "23211"
		}
	}

The patient object contains demographics about the patient. The patient might be the subscriber or a dependent. This is indicated by the subscriberRelationship and subscriberRelationshipCode properties. The updateYourRecords property indicates whether the demographics you sent to the health plan are out of date and should be updated with the demographics presented here.

	"patient" : {
		"firstName" : "JANE",
		"middleName" : "C",
		"lastName" : "KIRK",
		"suffix" : "PMP",
		"patientAccountNumber" : "1232141-12",
		"memberId" : "ASDF12345",
		"familyUnitNumber" : "1",
		"subscriberRelationship" : "Spouse",
		"subscriberRelationshipCode" : "01",
		"gender" : "Female",
		"genderCode" : "F",
		"ssn" : "213329991",
		"birthDate" : "1983-04-28T00:00:00.000+0000",
		"deathDate" : "2017-05-01T00:00:00.000+0000",
		"address" : {
			"line1" : "123 MAIN ST",
			"line2" : "SUITE 1",
			"city" : "JACKSONVILLE",
			"state" : "Florida",
			"stateCode" : "FL",
			"zipCode" : "23211"
		},
		"updateYourRecords" : false
	}

The payer object contains information about the health plan that returned this coverage information. The payerId property is the health plan's Availity id. We also return any known contact information for the health plan in the contactInformation array.

	"payer" : {
		"payerId" : "BCBSF",
		"payerName" : "FLORIDA BLUE",
		"contactInformation" : [{
			"name" : "BILLING DEPT",
			"phone" : "1-800-123-4567",
			"workPhone" : "1-800-123-4567 x120",
			"fax" : "1-800-234-4321",
			"emailAddress" : "ASDF@EXAMPLE.COM",
			"url" : "WWW.EXAMPLE.COM",
			"ediAccessNumber" : "12341123"
		}]
	}

The requestingProvider object contains information about the provider that requested this coverage information. This includes information sent on the request to the health plan and any additional information the health plan returned about that provider.

	"requestingProvider" : {
		"name" : "Business Name",
		"lastName" : "LAST",
		"firstName" : "FIRST",
		"middleName" : "MIDDLE",
		"npi" : "1234567893",
		"taxId" : "111222333",
		"payerAssignedProviderId" : "U1283",
		"ein" : "111222333",
		"ssn" : "111222333",
		"payerId" : "12939",
		"pharmacyProcessorNumber" : "123123",
		"planId" : "2148124",
		"stateLicenseNumber" : "123129312",
		"medicareProviderNumber" : "1231243",
		"medicaidProviderNumber" : "891823",
		"facilityId" : "9127371",
		"pin" : "1112",
		"contractNumber" : "2391781-1",
		"electronicPin" : "1293",
		"submitterId" : "G1923",
		"payerAssignedUserId" : "E1231",
		"providerPlanNetworkId" : "19231-12",
		"facilityNetworkId" : "123123-312",
		"specialty" : "HOSPITAL",
		"specialtyCode" : "282N00000X",
		"role" : "Admitting",
		"roleCode" : "AD" 
	}

The plans array contains any health plans returned for the member. Each plan has an overall status indicated by the status and statusCode properties. We also return any pertinent identifiers and dates tied to the plan.

	"plans" : [{
		"status" : "Active",
		"statusCode" : "1",
		"groupNumber" : "12314",
		"groupName" : "EXAMPLE COMPANY",
		"policyNumber" : "219312",
		"planNumber" : "213124",
		"planName" : "BLUE OPTIONS",
		"planNetworkId" : "213123",
		"planNetworkName" : "EXAMPLE NETWORK",
		"contractClassCode" : "21312",
		"contractNumber" : "41257",
		"medicalRecordNumber" : "238124",
		"healthInsuranceClaimNumbe" : "184891",
		"identificationCardSerialNumber" : "12939123",
		"identityCardNumber" : "1239123",
		"issueNumber" : "1",
		"medicaidRecipientIdentificationNumber" : "123123",
		"priorIdentificationNumber" : "13141",
		"agencyClaimNumber" : "141",
		"caseNumber" : "189923-1",
		"admissionDate" : "2017-04-21T00:00:00.000+0000",
		"dischargeDate" : "2017-05-01T00:00:00.000+0000",
		"issueDate" : "2017-05-01T00:00:00.000+0000",
		"serviceDate" : "2017-05-01T00:00:00.000+0000",
		"coverageStartDate" : "2017-01-01T00:00:00.000+0000",
		"coverageEndDate" : "2017-12-31T00:00:00.000+0000",
		"planStartDate" : "2017-01-01T00:00:00.000+0000",
		"planEndDate" : "2017-12-31T00:00:00.000+0000",
		"planEnrollmentDate" : "2017-01-01T00:00:00.000+0000",
		"certificationDate" : "2017-01-01T00:00:00.000+0000",
		"eligibilityStartDate" : "2017-01-01T00:00:00.000+0000",
		"eligibilityEndDate" : "2017-12-31T00:00:00.000+0000",
		"policyEffectiveDate" : "2017-01-01T00:00:00.000+0000",
		"policyExpirationDate" : "2017-12-31T00:00:00.000+0000",
		"effectiveChangeDate" : "2017-01-01T00:00:00.000+0000",
		"cobraStartDate" : "2017-01-01T00:00:00.000+0000",
		"cobraEndDate" : "2017-12-31T00:00:00.000+0000",
		"lastUpdateDate" : "2017-01-01T00:00:00.000+0000",
		"addedDate" : "2017-01-01T00:00:00.000+0000",
		"premiumPaidToBeginDate" : "2017-01-01T00:00:00.000+0000",
		"premiumPaidToEndDate" : "2017-12-31T00:00:00.000+0000",
		"statusDate" : "2017-01-01T00:00:00.000+0000",
		"additionalPayers" : [...],
		"primaryCareProvider" : {...},
		"contacts" : [...],
		"payerNotes" : [...],
		"preexistingConditions" : {...},
		"benefits" : [...]
	}]

A plan can contain information about other health plans in the additionalPayers array. This includes various identifiers, dates, and member information associated with the other healthplan. The primary, secondary, and tertiary properties indicate how this health plan participates in coordination of benefits for the member.

	"additionalPayers" : [{
		"name" : "Example Insurance",
		"type" : "Commercial",
		"typeCode" : "C1",
		"planNumber" : "128318",
		"planName" : "Sample Plan",
		"groupNumber" : "81283",
		"groupName" : "Example Group",
		"policyNumber" : "8123",
		"planNetworkId" : "123",
		"planNetworkName" : "Example Network",
		"dischargeDate" : "2017-01-01T00:00:00.000+0000",
		"periodStartDate" : "2017-01-01T00:00:00.000+0000",
		"periodEndDate" : "2017-12-31T00:00:00.000+0000",
		"completionDate" : "2017-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsBeginDate" : "2017-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsEndDate" : "2017-12-31T00:00:00.000+0000",
		"coordinationOfBenefitsDate" : "2017-01-01T00:00:00.000+0000",
		"coverageStartDate" : "2017-01-01T00:00:00.000+0000",
		"coverageEndDate" : "2017-12-31T00:00:00.000+0000",
		"addedDate" : "2017-01-01T00:00:00.000+0000",
		"planStartDate" : "2017-01-01T00:00:00.000+0000",
		"benefitBeginDate" : "2017-01-01T00:00:00.000+0000",
		"benefitEndDate" : "2017-12-31T00:00:00.000+0000",
		"primaryCareProviderDate" : "2017-01-01T00:00:00.000+0000",
		"lastVisitDate" : "2017-01-01T00:00:00.000+0000",
		"eligibilityStartDate" : "2017-01-01T00:00:00.000+0000",
		"eligibilityEndDate" : "2017-01-01T00:00:00.000+0000",
		"admissionDate" : "2017-01-01T00:00:00.000+0000",
		"serviceDate" : "2017-01-01T00:00:00.000+0000",
		"lastUpdateDate" : "2017-01-01T00:00:00.000+0000",
		"statusDate" : "2017-01-01T00:00:00.000+0000",
		"payerNotes" : ["This is a note from the secondary payer."],
		"payerId" : "00590",
		"contactInformation" : [{
			"name" : "Billing Dept",
			"phone" : "1-800-234-1234 x12",
			"fax" : "1-800-345-1234 x12",
			"emailAddress" : "api@availity.com",
			"ediAccessNumber" : "1238",
			"url" : "www.availity.com",
			"workPhone" : "555-123-3122 x151
		}],
		"address" : {
			"line1" : "123 Main St",
			"line2" : "Suite 15",
			"city" : "Jacksonville",
			"state" : "Florida",
			"stateCode" : "FL",
			"zipCode" : "237812123"
		},
		"primary" : false,
		"secondary" : true,
		"tertiary" : false,
		"insuredLastName" : "",
		"insuredFirstName" : "",
		"insuredMiddleName" : "",
		"insuredMemberId" : "",
		"insuredContactInformation" : [{
			"name" : "Resident",
			"phone" : "9042312134 x12",
			"fax" : "5555554444 x12",
			"emailAddress" : "bob@example.com",
			"ediAccessNumber" : "1238",
			"url" : "www.example.com",
			"workPhone" : "555-123-3122 x152
		}],
		"insuredAddress" : {
			"line1" : "123 Main St",
			"line2" : "Suite 12",
			"city" : "Jacksonville",
			"state" : "Florida",
			"stateCode" : "FL",
			"zipCode" : "237812123"
		}
	}]

The primaryCareProvider object contains any information returned by the health plan about the member's primary care provider. This information includes any known identifiers, pertinent dates, and contact information for that primary care provider.

	"primaryCareProvider" : {
		"name" : "Medical Center",
		"lastName" : "Smith",
		"firstName" : "Joe",
		"middleName" : "D",
		"npi" : "1234567893",
		"taxId" : "111222333",
		"payerAssignedProviderId" : "G1234",
		"ein" : "128312314",
		"ssn" : "111222333",
		"etin" : "123123",
		"facilityId" : "21312",
		"suhi" : "4123",
		"memberId" : "12312",
		"naicId" : "123214",
		"payerId" : "44431",
		"pharmacyProcessorNumber" : "123123",
		"planId" : "123124",
		"address" : {
			"line1" : "123 Main St",
			"line2" : "Suite 1",
			"city" : "Jacksonville",
			"state" : "Florida",
			"stateCode" : "FL",
			"zipCode" : "612312341"
		},
		"specialty" : "HOSPITAL",
		"specialtyCode" : "282N00000X",
		"role" : "Admitting",
		"roleCode" : "AD",
		"contactInformation" : [{
			"name" : "Dr Smith",
			"phone" : "9042312134 x12",
			"fax" : "5555554444 x12",
			"emailAddress" : "bob@example.com",
			"ediAccessNumber" : "1238",
			"url" : "www.example.com",
			"workPhone" : "555-123-3122 x152
		}],
		"dischargeDate" : "2017-01-01T00:00:00.000+0000",
		"periodStartDate" : "2017-01-01T00:00:00.000+0000",
		"periodEndDate" : "2017-01-01T00:00:00.000+0000",
		"completionDate" : "2017-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsBeginDate" : "2017-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsEndDate" : "2017-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsDate" : "2017-01-01T00:00:00.000+0000",
		"coverageStartDate" : "2017-01-01T00:00:00.000+0000",
		"coverageEndDate" : "2017-01-01T00:00:00.000+0000",
		"addedDate" : "2017-01-01T00:00:00.000+0000",
		"planStartDate" : "2017-01-01T00:00:00.000+0000",
		"benefitBeginDate" : "2017-01-01T00:00:00.000+0000",
		"benefitEndDate" : "2017-01-01T00:00:00.000+0000",
		"primaryCareProviderDate" : "2017-01-01T00:00:00.000+0000",
		"lastVisitDate" : "2017-01-01T00:00:00.000+0000",
		"eligibilityStartDate" : "2017-01-01T00:00:00.000+0000",
		"eligibilityEndDate" : "2017-01-01T00:00:00.000+0000",
		"admissionDate" : "2017-01-01T00:00:00.000+0000",
		"serviceDate" : "2017-01-01T00:00:00.000+0000",
		"lastUpdateDate" : "2017-01-01T00:00:00.000+0000",
		"statusDate" : "2017-01-01T00:00:00.000+0000",
		"policyNumber" : "2134",
		"familyUnitNumber" : "1",
		"groupNumber" : "1231",
		"referralNumber" : "12312",
		"alternateListId" : "32154",
		"coverageListId" : "78123",
		"healthInsuranceClaimNumber" : "12",
		"drugFormularyNumber" : "491123",
		"priorAuthorizationNumber" : "1238123",
		"medicalAssistanceCategoryId" : "2139123",
		"planNetworkId" : "19283",
		"medicaidRecipientId" : "123123",
		"deliveryInformation" : [{
			"quantityQualifier" : "Visits",
			"quantityQualifierCode" : "VS",
			"quantity" : "12",
			"amount" : "3",
			"per" : "Week",
			"perCode" : "WK",
			"timePeriod" : "Month",
			"timePeriodCode" : "34"
			"timePeriods" : "2",
			"pattern" : "Monday, Wednesday and Thursday",
			"patternCode" : "SY",
			"time" : "A.M.",
			"timeCode" : "D"
		}],
		"payerNotes" : ["The is a note from the payer about the primary care provider."]
	}

The contacts array contains any other general contact information provided. This object contains any identifiers, pertinent dates, and contact information for the contact.

	"contacts" : [{
		"name" : "Joe's Discount Health Plan",
		"lastName" : "Smith",
		"firstName" : "Joe",
		"middleName" : "D",
		"npi" : "1234567893",
		"taxId" : "111222333",
		"payerAssignedProviderId" : "G1234",
		"ein" : "128312314",
		"ssn" : "111222333",
		"etin" : "123123",
		"facilityId" : "21312",
		"suhi" : "4123",
		"memberId" : "12312",
		"naicId" : "123214",
		"payerId" : "44431",
		"pharmacyProcessorNumber" : "123123",
		"planId" : "123124",
		"address" : {
			"line1" : "123 Main St",
			"line2" : "Suite 1",
			"city" : "Jacksonville",
			"state" : "Florida",
			"stateCode" : "FL",
			"zipCode" : "612312341"
		},
		"specialty" : "HOSPITAL",
		"specialtyCode" : "282N00000X",
		"type" : "Prior Insurance Carrier",
		"typeCode" : "P4",
		"role" : "Admitting",
		"roleCode" : "AD",
		"contactInformation" : [{
			"name" : "Dr Smith",
			"phone" : "9042312134 x12",
			"fax" : "5555554444 x12",
			"emailAddress" : "bob@example.com",
			"ediAccessNumber" : "1238",
			"url" : "www.example.com",
			"workPhone" : "555-123-3122 x152
		}],
		"dischargeDate" : "2014-01-01T00:00:00.000+0000",
		"periodStartDate" : "2014-01-01T00:00:00.000+0000",
		"periodEndDate" : "2014-01-01T00:00:00.000+0000",
		"completionDate" : "2014-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsBeginDate" : "2014-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsEndDate" : "2014-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsDate" : "2014-01-01T00:00:00.000+0000",
		"coverageStartDate" : "2014-01-01T00:00:00.000+0000",
		"coverageEndDate" : "2014-01-01T00:00:00.000+0000",
		"addedDate" : "2014-01-01T00:00:00.000+0000",
		"planStartDate" : "2014-01-01T00:00:00.000+0000",
		"benefitBeginDate" : "2014-01-01T00:00:00.000+0000",
		"benefitEndDate" : "2014-01-01T00:00:00.000+0000",
		"primaryCareProviderDate" : "2014-01-01T00:00:00.000+0000",
		"lastVisitDate" : "2014-01-01T00:00:00.000+0000",
		"eligibilityStartDate" : "2014-01-01T00:00:00.000+0000",
		"eligibilityEndDate" : "2014-01-01T00:00:00.000+0000",
		"admissionDate" : "2014-01-01T00:00:00.000+0000",
		"serviceDate" : "2014-01-01T00:00:00.000+0000",
		"lastUpdateDate" : "2014-01-01T00:00:00.000+0000",
		"statusDate" : "2014-01-01T00:00:00.000+0000",
		"policyNumber" : "2134",
		"familyUnitNumber" : "1",
		"groupNumber" : "1231",
		"referralNumber" : "12312",
		"alternateListId" : "32154",
		"coverageListId" : "78123",
		"healthInsuranceClaimNumber" : "12",
		"drugFormularyNumber" : "491123",
		"priorAuthorizationNumber" : "1238123",
		"medicalAssistanceCategoryId" : "2139123",
		"planNetworkId" : "19283",
		"medicaidRecipientId" : "123123",
		"authorizationRequired" : true,
		"deliveryInformation" : [{
			"quantityQualifier" : "Visits",
			"quantityQualifierCode" : "VS",
			"quantity" : "12",
			"amount" : "3",
			"per" : "Week",
			"perCode" : "WK",
			"timePeriod" : "Month",
			"timePeriodCode" : "34"
			"timePeriods" : "2",
			"pattern" : "Monday, Wednesday and Thursday",
			"patternCode" : "SY",
			"time" : "A.M.",
			"timeCode" : "D"
		}],
		"payerNotes" : ["The is a note from the payer about the primary care provider."]
	}]

The payerNotes array contains general disclaimers and messages from the health plan.

	"payerNotes" : [{
		"type" : "Disclaimer",
		"typeCode" : "D",
		"message" : "This is a disclaimer!"
	}]

The preexistingConditions contains any general information about coverage of pre-existing conditions returned by the health plan. This object is organized by network with each network array containing detailed benefit information (see benefit detail object below).

	"preexistingConditions" : {
		"inNetwork" : [...],
		"outOfNetwork" : [...],
		"notApplicableNetwork" : [...],
		"noNetwork" : [...]
	}

The benefits array contains detailed information about coverage of various benefits. It is organized by service type with each entry containing benefit information about a particular service type. The name and type properties identify the service type this benefit pertains to.

The benefit has an overall status indicated by the status and statusCode properties. Additional status information is broken down in the statusDetails object. This object is organized by network with each network array containing detailed benefit information (see benefit detail object below).

Financial information about the benefit is contained in the amounts object. You can find information about the co-pay, out-of-pocket expenses, deductibles, and co-insurance here. Each of these financial sections is organized by network with each network array containing detailed benefit information (see benefit detail object below).

Limitations on this benefit are described in the limitations object. It is also organized by network with each network array containing detailed benefit information (see benefit detail object below).

Non-covered information is located in the nonCovered property. This object is organized by network with each network array containing detailed benefit information (see benefit detail object below).

Coverage basis information is located in the coverageBasis property. This object is organized by network with each network array containing detailed benefit information (see benefit detail object below).

Information about pre-existing conditions is located in the preexistingConditions property. This object is organized by network with each network array containing detailed benefit information (see benefit detail object below).

Additional health plans that cover this particular benefit are specified in the additionalPayers array. This array contains the same type of object with the same possible properties as the plan-level additionalPayers array.

Contacts related to this particular benefit are specified in the contacts array. This array contains the same type of object with the same possible properties as the plan level contacts array.

The payerNotes array contains any notes from the health plan that pertain to this particular benefit.

	"benefits" : [{
		"name" : "Medical Care",
		"type" : "1",
		"status" : "Active",
		"statusCode" : "1",
		"statusDetails" : {
			"inNetwork" : [...],
			"outOfNetwork" : [...],
			"notApplicableNetwork" : [...],
			"noNetwork" : [...]
		},
		"amounts" : {
			"coPayment" : {
				"inNetwork" : [...],
				"outOfNetwork" : [...],
				"notApplicableNetwork" : [...],
				"noNetwork" : [...]
			},
			"outOfPocket" : {
				"inNetwork" : [...],
				"outOfNetwork" : [...],
				"notApplicableNetwork" : [...],
				"noNetwork" : [...]
			},
			"deductibles" : {
				"inNetwork" : [...],
				"outOfNetwork" : [...],
				"notApplicableNetwork" : [...],
				"noNetwork" : [...]
			},
			"coInsurance" : {
				"inNetwork" : [...],
				"outOfNetwork" : [...],
				"notApplicableNetwork" : [...],
				"noNetwork" : [...]
			}
		},
		"limitations" : {
			"inNetwork" : [...],
			"outOfNetwork" : [...],
			"notApplicableNetwork" : [...],
			"noNetwork" : [...]
		},
		"nonCovered" : {
			"inNetwork" : [...],
			"outOfNetwork" : [...],
			"notApplicableNetwork" : [...],
			"noNetwork" : [...]
		},
		"coverageBasis" : {
			"inNetwork" : [...],
			"outOfNetwork" : [...],
			"notApplicableNetwork" : [...],
			"noNetwork" : [...]
		},
		"preexistingConditions" : {
			"inNetwork" : [...],
			"outOfNetwork" : [...],
			"notApplicableNetwork" : [...],
			"noNetwork" : [...]
		},
		"additionalPayers : [...],
		"contacts : [...],
		"payerNotes : [{
			"type" : "Disclaimer",
			"typeCode" : "D",
			"message" : "This is a disclaimer!"
		}]
	}]

Information about benefits is conveyed in the benefit-detail format. This can include specific status information about an aspect of a benefit (status and statusCode), financial information (amount, total remaining), where service should be performed (placeOfService and placeOfServiceCode), dates pertaining to this detail, contacts related to this detail (the same contact object as the plan and benefit-level contacts), and even information about how a service should be delivered deliveryInformation.

	{
		"status" : "Active",
		"statusCode" : "1",
		"insuranceType" : "Point of Service (POS)",
		"insuranceTypeCode" : "PS",
		"amount" : "50.00",
		"units" : "USD",
		"amountTimePeriod" : "Visit",
		"amountTimePeriodCode" : "27",
		"remaining" : "25.00",
		"remainingTimePeriod" : "Visit",
		"remainingTimePeriodCode" : "27",
		"total" : "25.00",
		"totalTimePeriod" : "Visit",
		"totalTimePeriodCode" : "27",
		"level" : "Family",
		"levelCode" : "FAM",
		"quantity" : "1",
		"quantityQualifier" : "Days",
		"quantityQualifierCode" : "DY",
		"authorizationRequired" : false,
		"placeOfService" : "Office",
		"placeOfServiceCode" : "11",
		"description" : "BASIC COVERAGE",
		"dischargeDate" : "2014-01-01T00:00:00.000+0000",
		"periodStartDate" : "2014-01-01T00:00:00.000+0000",
		"periodEndDate" : "2014-01-01T00:00:00.000+0000",
		"completionDate" : "2014-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsDate" : "2014-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsBeginDate" : "2014-01-01T00:00:00.000+0000",
		"coordinationOfBenefitsEndDate" : "2014-01-01T00:00:00.000+0000",
		"coverageStartDate" : "2014-01-01T00:00:00.000+0000",
		"coverageEndDate" : "2014-01-01T00:00:00.000+0000",
		"addedDate" : "2014-01-01T00:00:00.000+0000",
		"planStartDate" : "2014-01-01T00:00:00.000+0000",
		"primaryCareProviderDate" : "2014-01-01T00:00:00.000+0000",
		"lastVisitDate" : "2014-01-01T00:00:00.000+0000",
		"eligibilityStartDate" : "2014-01-01T00:00:00.000+0000",
		"eligibilityEndDate" : "2014-01-01T00:00:00.000+0000",
		"benefitBeginDate" : "2014-01-01T00:00:00.000+0000",
		"benefitEndDate" : "2014-01-01T00:00:00.000+0000",
		"admissionDate" : "2014-01-01T00:00:00.000+0000",
		"serviceDate" : "2014-01-01T00:00:00.000+0000",
		"lastUpdateDate" : "2014-01-01T00:00:00.000+0000",
		"statusDate" : "2014-01-01T00:00:00.000+0000",
		"contacts" : [...],
		"payerNotes" : ["A note from the payer."],
		"deliveryInformation" : [{
			"quantityQualifier" : "Visits",
			"quantityQualifierCode" : "VS",
			"quantity" : "12",
			"amount" : "3",
			"per" : "Week",
			"perCode" : "WK",
			"timePeriod" : "Month",
			"timePeriodCode" : "34"
			"timePeriods" : "2",
			"pattern" : "Monday, Wednesday and Thursday",
			"patternCode" : "SY",
			"time" : "A.M.",
			"timeCode" : "D"
		}]
	}

Coverage Response Field Mapping Tables

Below you will find tables that provide mapping to various fields in the resource response.

The following are possible values for insuranceTypeCode and insuranceType fields:

Insurance Type Code	Insurance Type
12	Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
13	Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
14	Medicare Secondary, No-fault Insurance Including Auto is Primary
15	Medicare Secondary Worker's Compensation
16	Medicare Secondary Public Health Service (PHS) or Other Federal Agency
41	Medicare Secondary Black Lung
42	Medicare Secondary Veteran's Adminstration
43	Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
47	Medicare Secondary, Other Liability Insurance is Primary
AP	Auto Insurance Policy
C1	Commercial
CO	Consolidated Omnibus Budget Reconciliation Act (COBRA)
CP	Medicare Conditionally Primary
D	Disability
DB	Disability Benefits
EP	Exclusive Provider Organization
FF	Family or Friends
GP	Group Policy
HM	Health Maintenance Organization (HMO)
HN	Health Maintenance Organization (HMO) - Medicare Risk
HS	Special Low Income Medicare Beneficiary
IN	Indemnity
IP	Individual Policy
LC	Long Term Care
LD	Long Term Policy
LI	Life Insurance
LT	Litigation
MA	Medicare Part A
MB	Medicare Part B
MC	Medicaid
MH	Medigap Part A
MI	Medigap Part B
MP	Medicare Primary
OT	Other
PE	Property Insurance - Personal
PL	Personal
PP	Personal Payment (Cash - No Insurance)
PR	Preferred Provider Organization (PPO)
PS	Point of Service (POS)
QM	Qualified Medicare Beneficiary
RP	Property Insurance - Real
SP	Supplemental Policy
TF	Tax Equity Fiscal Responsibility Act (TEFRA)
WC	Workers Compensation
WU	Wrap Up Policy

The following are possible values for subscriberRelationshipCode and subscriberRelationship fields:

Subscriber Relationship Code	Subscriber Relationship
18	Self
01	Spouse
19	Child
20	Employee
21	Unknown
39	Organ Donor
40	Cadaver Donor
53	Life Partner
G8	Other Relationship
34	Other Adult

The following are possible values for levelCode and level fields:

Level Code	Level
CHD	Children Only
DEP	Dependents Only
ECH	Employee and Children
EMP	Employee Only
ESP	Employee and Spouse
FAM	Family
IND	Individual
SPC	Spouse and Children
SPO	Spouse Only

The following are possible values for timePeriodCode and timePeriod fields:

Time Period Code	Time Period
6	Hour
7	Day
13	24 Hours
21	Years
22	Service Year
23	Calendar Year
24	Year to Date
25	Contract
26	Episode
27	Visit
28	Outlier
29	Remaining
30	Exceeded
31	Not Exceeded
32	Lifetime
33	Lifetime Remaining
34	Month
35	Week
36	Admission

The following are possible values for statusCode and status fields for plans and benefits:

Status Code	Status
0	Coverage Unknown
1	Active Coverage
2	Active - Full Risk Capitation
3	Active - Services Capitated
4	Active - Services Capitated to Primary Care Physician
5	Active - Pending Investigation
6	Inactive
7	Inactive - Pending Eligibility Update
8	Inactive - Pending Investigation

The following are possible values for quantityQualifierCode and quantityQualifier fields:

Quantity Qualifier Code	Quantity Qualifier
8H	Minimum
99	Quantity Used
CA	Covered - Actual
CE	Covered - Estimated
D3	Number of Co-insurance Days
DB	Deductible Blood Units
DY	Days
HS	Hours
LA	Life-time Reserve - Actual
LE	Life-time Reserve - Estimated
M2	Maximum
MN	Month
P6	Number of Services or Procedures
QA	Quantity Approved
S7	Maximum Age
S8	Minimum Age
VS	Visits
YY	Years

The following are possible values for categoryCode and category fields for various contacts and Coverages.requestingProvider and Coverages.plans.primaryCareProvider:

Category Code	Category
1	Active Coverage
2	Active - Full Risk Capitation
3	Active - Services Capitated
4	Active - Services Capitated to Primary Care Physician
5	Active - Pending Investigation
6	Inactive
7	Inactive - Pending Eligibility Update
8	Inactive - Pending Investigation
A	Co-Insurance
B	Co-Payment
C	Deductible
CB	Coverage Basis
D	Benefit Description
E	Exclusions
F	Limitations
G	Out of Pocket (Stop Loss)
H	Unlimited
I	Non-Covered
J	Cost Containment
K	Reserve
L	Primary Care Provider
M	Pre-existing Condition
MC	Managed Care Coordinator
N	Services Restricted to Following Provider
O	Not Deemed a Medical Necessity
P	Benefit Disclaimer
Q	Second Surgical Opinion Required
R	Other or Additional Payor
S	Prior Year(s) History
T	Card(s) Reported Lost/Stolen
U	Contact Following Entity for Eligibility or Benefit Information
V	Cannot Process
W	Other Source of Data
X	Health Care Facility
Y	Spend Down

The following are possible values for placeOfServiceCode and placeOfService fields:

Place of Service Code	Place of Service
01	Pharmacy
03	School
04	Homeless Shelter
05	Indian Health Service Free-standing Facility
06	Indian Health Service Provider-based Facility
07	Tribal 638 Free-standing Facility
08	Tribal 638 Provider-based Facility
11	Office
12	Home
13	Assisted Living Facility
14	Group Home
15	Mobile Unit
19	Off Campus-Outpatient Hospital
20	Urgent Care Facility
21	Inpatient Hospital
22	On Campus-Outpatient Hospital
23	Emergency Room - Hospital
24	Ambulatory Surgical Center
25	Birthing Center
26	Military Treatment Facility
31	Skilled Nursing Facility
32	Nursing Facility
33	Custodial Care Facility
34	Hospice
41	Ambulance - Land
42	Ambulance - Air or Water
49	Independent Clinic
50	Federally Qualified Health Center
51	Inpatient Psychiatric Facility
52	Psychiatric Facility - Partial Hospitalization
53	Community Mental Health Center
54	Intermediate Care Facility/Mentally Retarded
55	Residential Substance Abuse Treatment Facility
56	Psychiatric Residential Treatment Center
57	Non-residential Substance Abuse Treatment Facility
60	Mass Immunization Center
61	Comprehensive Inpatient Rehabilitation Facility
62	Comprehensive Outpatient Rehabilitation Facility
65	End-State Renal Disease Treatment Facility
71	Public Health Clinic
72	Rural Health Clinic
81	Independent Laboratory
99	Other Place of Service

The following are possible values for typeCode and code fields:

Note: In addition to the following list, type could also be a procedureCode.

Type Code	Code
85	AIDS
84	Abortion
64	Acupuncture
28	Adjunctive Dental Services
57	Air Transportation
AJ	Alcoholism
GY	Allergy
79	Allergy Testing
15	Alternate Method Dialysis
13	Ambulatory Service Center Facility
7	Anesthesia
97	Anesthesiologist
71	Audiology Exam
10	Blood Charges
91	Brand Name Prescription Drug
B2	Brand Name Prescription Drug - Formulary
B3	Brand Name Prescription Drug - Non-Formulary
B1	Burn Care
58	Cabulance
87	Cancer
BL	Cardiac
BG	Cardiac Rehabilitation
CQ	Case Management
78	Chemotherapy
33	Chiropractic
34	Chiropractic Office Visits
16	Chronic Renal Disease (CRD) Equipment
BD	Cognitive Therapy
3	Consultation
C1	Coronary Care
BC	Day Care (Psychiatric)
37	Dental Accident
35	Dental Care
36	Dental Crowns
DG	Dermatology
DS	Diabetic Supplies
23	Diagnostic Dental
5	Diagnostic Lab
73	Diagnostic Medical
4	Diagnostic X-Ray
76	Dialysis
63	Donor Procedures
AK	Drug Addiction
DM	Durable Medical Equipment
12	Durable Medical Equipment Purchase
18	Durable Medical Equipment Rental
86	Emergency Services
BP	Endocrine
26	Endodontics
AR	Experimental Drug Therapy
BR	Eye
CP	Eyewear and Eyewear Accessories
82	Family Planning
CO	Flu Vaccination
AM	Frames
89	Free Standing Prescription Drug
BN	Gastrointestinal
60	General Benefits
92	Generic Prescription Drug
GF	Generic Prescription Drug - Formulary
GN	Generic Prescription Drug - Non-Formulary
BT	Gynecological
30	Health Benefit Plan Coverage
42	Home Health Care
43	Home Health Prescriptions
44	Home Health Visits
45	Hospice
47	Hospital
53	Hospital - Ambulatory Surgical
51	Hospital - Emergency Accident
52	Hospital - Emergency Medical
48	Hospital - Inpatient
50	Hospital - Outpatient
49	Hospital - Room and Board
80	Immunizations
61	In-vitro Fertilization
BA	Independent Medical Evaluation
83	Infertility
72	Inhalation Therapy
IC	Intensive Care
BS	Invasive Procedures
AO	Lenses
59	Licensed Ambulance
54	Long Term Care
BM	Lymphatic
62	MRI/CAT Scan
90	Mail Order Prescription Drug
BW	Mail Order Prescription Drug: Brand Name
BX	Mail Order Prescription Drug: Generic
55	Major Medical
CM	Mammogram, High Risk Patient
CN	Mammogram, Low Risk Patient
BE	Massage Therapy
69	Maternity
27	Maxillofacial Prosthetics
1	Medical Care
56	Medically Related Transportation
MH	Mental Health
CG	Mental Health Facility - Inpatient
CH	Mental Health Facility - Outpatient
CE	Mental Health Provider - Inpatient
CF	Mental Health Provider - Outpatient
NI	Neonatal Intensive Care
BQ	Neurology
65	Newborn Care
AQ	Nonmedically Necessary Physical
BI	Nursery
BU	Obstetrical
BV	Obstetrical/Gynecological
AD	Occupational Therapy
ON	Oncology
40	Oral Surgery
38	Orthodontics
BK	Orthopedic
9	Other Medical
77	Otological Exam
BB	Partial Hospitalization (Psychiatric)
66	Pathology
BH	Pediatric
24	Periodontics
88	Pharmacy
AE	Physical Medicine
PT	Physical Therapy
BY	Physician Visit - Office: Sick
BZ	Physician Visit - Office: Well
32	Plan Waiting Period
19	Pneumonia Vaccine
93	Podiatry
95	Podiatry - Nursing Home Visits
94	Podiatry - Office Visits
17	Pre-Admission Testing
74	Private Duty Nursing
CB	Private Duty Nursing - Home
CA	Private Duty Nursing - Inpatient
96	Professional (Physician)
A3	Professional (Physician) Visit - Home
99	Professional (Physician) Visit - Inpatient
A1	Professional (Physician) Visit - Nursing Home
98	Professional (Physician) Visit - Office
A0	Professional (Physician) Visit - Outpatient
A2	Professional (Physician) Visit - Skilled Nursing Facility
75	Prosthetic Device
39	Prosthodontics
A4	Psychiatric
A7	Psychiatric - Inpatient
A8	Psychiatric - Outpatient
A5	Psychiatric - Room and Board
A6	Psychotherapy
PU	Pulmonary
BF	Pulmonary Rehabilitation
6	Radiation Therapy
A9	Rehabilitation
AB	Rehabilitation - Inpatient
AC	Rehabilitation - Outpatient
AA	Rehabilitation - Room and Board
RN	Renal
14	Renal Supplies in the Home
RT	Residential Psychiatric Treatment
46	Respite Care
25	Restorative
41	Routine (Preventive) Dental
AN	Routine Exam (Vision)
81	Routine Physical
CL	Screening Laboratory
CK	Screening X-ray
20	Second Surgical Opinion
AG	Skilled Nursing Care
AH	Skilled Nursing Care - Room and Board
BJ	Skin
67	Smoking Cessation
22	Social Work
AF	Speech Therapy
AI	Substance Abuse
CI	Substance Abuse Facility - Inpatient
CJ	Substance Abuse Facility - Outpatient
2	Surgical
8	Surgical Assistance
CD	Surgical Benefits - Facility
CC	Surgical Benefits - Professional (Physician)
21	Third Surgical Opinion
TC	Transitional Care
TN	Transitional Nursery Care
70	Transplants
UC	Urgent Care
11	Used Durable Medical Equipment
AL	Vision (Optometry)
68	Well Baby Care

DELETE /V1/COVERAGES/:ID

You can delete a particular coverage by issuing a DELETE against it.

When you make a valid request, the resource will return a status code of 204 if the resource was successfully deleted.

	$ curl -X DELETE "https://api.availity.com/availity/v1/coverages/0001194499098175762045868562105833796329766732695450956940743265"
	->
	HTTP/1.1 204 No Content
	x-api-id: 54cbda17-e010-44f3-a38c-b038c106e0bf
	X-Session-ID: 54cbda17-e010-44f3-a38c-b038c106e0bf
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Tue, 24 Feb 2015 20:58:03 GMT
	X-Global-Transaction-ID: 34319985
	Connection: close

Configurations

The Configurations service is an extremely powerful API that will make building custom applications that support multiple health plans very easy.

If you've ever tried to support access to multiple heath plans in your application you know how difficult this can be. Even though there are standards in place, such as ASC X12 transactions and HL7, a lot of health plans will support these standards at different levels. This would traditional leave the burden up to you, the developer, on how to normalize this inforamtion across a range of health plans you need to support.

This is where the Availity Configurations API will help save you many weeks of development time. It provides details for each payer we support and provides details such as what are the required fields for a specific payer, required field combinations, validation patterns that can be used by your front end applications, code/values for populating selection groups, etc.

All of this information is kept up to date with the health plans. By utilizing this service to build your application you can ensure you always have the most current data and validation requirements and make them available to your application.

The Resource

Field	Type	Description
type	String	The type of resource that this Configuration describes.
subtypeId	String	The subtype of the resource that this Configuration describes.
subtypeValue	String	A description of the subtype of the resources that this Configurations describes.
payerId	String	The id of the health plan that this Configuration is for.
payerName	String	The name of the health plan that this Configuration is for.
elements	Object	The elements object describes the input rules for each component of the resource.
requiredFieldCombinations	Object	The requiredFieldCombinations object provides groups of minimum required fields that can be entered. At least one of each entry must be satisfied.

Example Use Case

Let's take a look at an example using this service that will allow us to discover what fields and field combinations are required to call the Coverages API. When you look at the Coverages documentation you will notice that for the GET request, all of the parameters are identified as Required: No.

The first thing you'll want to do to begin using the Coverages service is to call the Configurations service and specify the type and payerId that you want to send a request to. The Coverages service type is 270 and you can find a list of supported payerId's on our developer portal here: Supported Health Plans.

Here is an excerpt from the Configurations service response for the payer Florida Blue:

	{
	  "configurations": [
		{
		  "type": "270",
		  "payerId": "BCBSF",
		  "payerName": "FLORIDA BLUE",
		  "elements": {
			"providerLastName": {
			  "type": "Text",
			  "label": "Provider Last Name",
			  "order": 0,
			  "allowed": true,
			  "required": false,
			  "errorMessage": "Please enter a valid Provider Last Name.",
			  "defaultValue": "AVAILITY",
			  "pattern": "^[a-zA-Z0-9\\s!&,()+'\\-./;?=#\\\\]{1,60}$",
			  "maxLength": 60
			},
			"providerFirstName": {
			  "type": "Text",
			  "label": "Provider First Name",
			  "order": 1,
			  "allowed": true,
			  "required": false,
			  "errorMessage": "Please enter a valid Provider First Name.",
			  "pattern": "^[a-zA-Z0-9\\s!&,()+'\\-./;?=#\\\\]{1,35}$",
			  "maxLength": 35
			},
			"providerType": {
			  "type": "Unsupported",
			  "label": "Provider Type",
			  "order": 2,
			  "allowed": false,
			  "required": false,
			  "errorMessage": "This field is not supported."
			},
			"providerNpi": {
			  "type": "Text",
			  "label": "Provider NPI",
			  "order": 4,
			  "allowed": true,
			  "required": false,
			  "errorMessage": "Enter a valid National Provider Identifier (NPI) containing 10 numeric digits and beginning with a 1, 2, 3, or 4.",
			  "pattern": "^[1-4][0-9]{9}$",
			  "maxLength": 10
			},
			"providerTaxId": {
			  "type": "Text",
			  "label": "Provider Tax ID",
			  "order": 5,
			  "allowed": true,
			  "required": false,
			  "errorMessage": "Enter a valid Tax ID containing nine numeric digits and no dashes.",
			  "pattern": "^[0-9]{9}$",
			  "maxLength": 9
			}
		  }
		}
	  ]
	}

The first part of the response shows the transaction type - 270 for Eligibility, the payer Id, and the payer name.

Under the elements object is where we find the list of fields this payer supports and whether they are required or not. If a parameter is not supported the field type is listed as Unsupported.

Let's look at the providerLastName parameter and walk through each of the attributes:

• type: The data type for this parameter.
• label: The name that can be used to display in your applications UI.
• order: An optional ordering index you can use when laying out fields in your applications UI.
• allowed: Boolean indicator specifying if this parameter is valid to use.
• required: Boolean indicator specifying if this parameter is required.
• errorMessage: An error message you can use in your applications UI if this field does not pass validation. This can be used if you perform client side validation or if this field is in error after you've submitted a request and it comes back invalid.
• defaultValue: A default value that can be used for pre-populating a field in your applications UI.
• pattern: A regular expression you can use to validate input parameter values.
• maxLength: The maximum legth allowed for this parameter.

Next let's look at the providerType paramter. The first thing we notice is the type attribute is of type Unsupported. That tells us that for this transaction type Florida Blue does not support the providerType parameter so we should not send it with our request.

GET /V1/CONFIGURATIONS

You can find and retrieve Configurations using this endpoint.

Parameters

Parameter	Type	Description
type	String	The type of configuration you are looking for.
subtypeId	String	The subtype id of the configuration you are looking for.
payerId	String	The health plan id of the configuration you are looking for.

Examples

	$ curl -X GET -i https://api.availity.com/availity/v1/configurations?type=270
	->
	HTTP/1.1 200 OK
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"totalCount": 2,
		"count": 2,
		"offset": 0,
		"limit": 50,
		"links": {
			"self": {
				"href": "https://api.availity.com/availity/v1/configurations?type=270"
			}
		},
		"configurations": [
			{
				"type": "270",
				"payerId": "BCBSF",
				"payerName" : "FLORIDA BLUE"
			},
			{
				"type": "270",
				"payerId": "HUMANA",
				"payerName" : "Humana"
			}
		]
	}

	$ curl -X GET -i https://api.availity.com/availity/v1/configurations?type=service-reviews&subtypeId=HS&payerId=BCBSF
	->
	HTTP/1.1 200 OK
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"totalCount": 1,
		"count": 1,
		"offset": 0,
		"limit": 50,
		"links": {
			"self": {
				"href": "https://api.availity.com/availity/v1/configurations?type=service-reviews&subtypeId=HS&payerId=BCBSF"
			}
		},
		"configurations": [
			{
				"type": "service-reviews",
				"subtypeId" : "HS",
				"subtypeValue" : "Health Service Review",
				"payerId": "BCBSF",
				"payerName" : "FLORIDA BLUE"
				"elements" : {
					"requestingProvider" : {
						"type": "Object",
						"order": 0,
						"allowed" : true,
						"required" : true,
						"elements" : {
							"npi" : {
								"type": "Text",
								"label": "Requesting Provider NPI",
								"order": 0,
								"allowed": true,
								"required": false,
								"errorMessage": "Enter a valid Requesting Provider NPI.",
								"pattern": "^[1-4][0-9]{9}$",
								"maxLength": 10
							},
							"taxId" : {
								"type": "Text",
								"label": "Requesting Provider Tax ID",
								"order": 1,
								"allowed": true,
								"required": false,
								"errorMessage": "Enter a valid Requesting Provider Tax ID",
								"pattern": "^[0-9]{9}$",
								"maxLength": 9
							}
						}
					},
					"patient" : {
						"type": "Object",
						"order": 1,
						"allowed" : true,
						"required" : true,
						"elements" {
							"birthDate" : {
								"type": "Date",
								"label": "Patient Date of Birth",
								"order": 0,
								"allowed": true,
								"required": true,
								"errorMessage": "Enter a valid date that is not in the future.",
								"min": "1870-01-01T05:00:00.000+0000",
								"max": "2015-05-06T03:59:59.999+0000"
							},
							"medicareCoverage" : {
								"type": "Boolean",
								"label": "Medicare Coverage",
								"order": 1,
								"allowed": false,
								"required": false,
								"errorMessage": "Please enter a valid Medicare Coverage.",
								"allowedWhen": {
									"serviceTypeCode": {
										"equalTo": "42"
									}
								},
								"requiredWhen": {
									"serviceTypeCode": {
										"equalTo": "42"
									}
								}
							}
						}
					},
					"serviceTypeCode" : {
						"type": "Enumeration",
						"label": "Type",
						"order": 2,
						"allowed": true,
						"required": true,
						"errorMessage": "Please enter a valid Service Type.",
						"mode": "DropDown",
						"values": [
							{
								"code": "1",
								"value": "Medical Care"
							},
							{
								"code": "42",
								"value": "Home Health Care"
							}
						]
					},
					"diagnoses" : {
						"type": "ObjectArray",
						"order": 3,
						"errorMessage": "Please enter between 1 and 12 valid Diagnoses.",
						"maxRepeats": 12,
						"allowed": true,
						"objectTypes": {
							"diagnosis": {
								"label": "Diagnosis",
								"maxInstances": 12,
								"required": true
							}
						},
						"elements": {
							"code": {
								"type": "Collection",
								"label": "Diagnosis Code",
								"order": 0,
								"allowed": true,
								"required": true,
								"errorMessage": "Please enter a valid Diagnosis Code.",
								"valuesWhen": {
									"qualifierCode" : [
										{
											"equalTo" : "BF",
											"values": {
												"href": "https://api.availity.com/availity/v1/codes?list=ICD9CMD"
											}
										}
									]
								}
							}
						}
					}
				},
				"requiredFieldCombinations" : {
					"requestingProvider" : [
						["npi"],
						["taxId"]
					]
				}
			}
		]
	}

Available Information

type	subtypeId	payerId	Usage
270	-	-	Returns the list of health plans that support Coverages.
270	-	a payer id	Returns the validation rules for Coverages for the specified health plan.
claim-statuses	-	-	Returns the list of payers that support ClaimStatues.
claim-statuses	-	a payer id	Returns the validation rules for ClaimStatuses for the specified payer.
professional-claims	-	-	Returns the list of payers that support ProfessionalClaims.
professional-claims	PRE_DETERMINATION	a payer id	Returns the validation rules for a predetermination ProfessionalClaim for the specified payer.
institutional-claims	-	-	Returns the list of payers that support InstitutionalClaims.
institutional-claims	PRE_DETERMINATION	a payer id	Returns the validation rules for a predetermination InstitutionalClaim for the specified payer.
service-reviews	-	-	Returns the list of health plans that support each type of ServiceReview.
service-reviews	-	a payer id	Returns the list of types of ServiceReviews supported by the specified health plan.
service-reviews	AR	-	Returns the list of health plans that support Admission Review (inpatient) ServiceReviews.
service-reviews	HS	-	Returns the list of health plans that support Health Services Review (outpatient) ServiceReviews.
service-reviews	SC	-	Returns the list of health plans that support Specialty Care Review (referral) ServiceReviews.
service-reviews	AR	a payer id	Returns the validation rules for Admission Review (inpatient) ServiceReviews for the specified health plan.
service-reviews	HS	a payer id	Returns the validation rules for Health Services Review (outpatient) ServiceReviews for the specified health plan.
service-reviews	SC	a payer id	Returns the validation rules for Specialty Care Review (referral) ServiceReviews.
service-reviews-inquiry	-	-	Returns the list of health plans that support ServiceReview inquiries.
service-reviews-inquiry	-	a payer id	Returns the validation rules for ServiceReview inquiries for the specified health plan.

Service Reviews

This resource represents a request to obtain authorization to perform a service or refer a patient to another provider. Your application can use the endpoints defined for it to find, create, and manage these requests.

WORKING WITH THE DEMO ENDPOINTS

Availity allows you to specify the type of response you want when interacting with our Service Review demonstration service by sending a header (X-Api-Mock-Scenario-ID) with the appropriate response scenario id. The supported response scenarios are listed below.

For POST methods send an empty JSON body such as: "{}"

Response Scenario ID	Method	HTTP Status	Description
SR-CreateRequestAccepted-i	POST	202	Availity is in the process of sending the member's service review information to the health plan.
SR-DeleteRequestAccepted-i	DELETE	202	Availity is processing your delete request.
SR-CreateRequestError-i	POST	400	Your request failed Availity's input validation rules.
SR-DeleteRequestError-i	DELETE	400	Your request failed Availity's delete validation rules.
SR-GetComplete-i	GET - use id 12345678	200	Availity has successfully retrieved the member's service review information from the health plan.
SR-GetInProgress-i	GET - use id 12345678	202	Availity is processing your request.
SR-GetPayerDown-i	GET - use id 12345678	504	Availity did not receive a response from the health plan within the time allotted. You should try your request again later.
SR-UpdateRequestAccepted-i	PUT	202	Availity is currently processing your request.
SR-UpdateRequestError-i	PUT	400	Your request failed Availity's input validation rules.
SR-GetPayerError-i	GET	400	The health plan indicated that something is wrong with the request. The resource should have a list of validationMessages. Correct and resubmit the request.
SR-GetRetrying-i	GET - use id 12345678	202	The health plan did not respond. Availity is retrying the request
SRI-GetAccepted-i	GET	202	Availity is currently processing your request.
SRI-GetComplete-i	GET	200	Availity has successfully retrieved the member's service review inquiry information from the health plan.
SRI-GetInProgress-i	GET	202	Availity is currently processing your request.
SRI-GetPayerError-i	GET	400	The health plan indicated that something is wrong with the request. The resource should have a list of validationMessages. Correct and resubmit the request.
SRI-GetPayerDown-i	GET	504	Availity did not receive a response from the health plan within the time allotted. You should try your request again later.
SRI-GetRetrying-i	GET – use id 12345678	202	The health plan did not respond. Availity is retrying the request
SRI-GetRequestError-i	GET	400	The health plan indicated that something is wrong with the request. The resource should have a list of validationMessages. Correct and resubmit the request

You can confirm you've received a mock response by inspecting the response headers. You should see the following header:

	X-Api-Mock-Response: true

THE RESOURCE

Field	Type	Description
id	String	A unique identifier that Availity has assigned to this ServiceReview.
createdDate	Timestamp	The date and time when this item was created in Availity's system.
updatedDate	Timestamp	The date and time when this item was last updated.
expirationDate	Timestamp	The date and time when this item will be removed from Availity's system.
customerId	String	The id of the Availity customer that owns this ServiceReview. Availity may ask for this during support calls.
controlNumber	String	The id of the last transaction associated with this ServiceReview. The health plan may ask for this during support calls.
updatable	boolean	A flag that indicates whether or not this ServiceReview can be updated.
updatableFields	String Array	Fields in this service review that can be updated.
deletable	boolean	A flag that indicates whether or not this ServiceReview can be deleted.
status	String	A description of the current status of this ServiceReview.
statusCode	String	A code that represents the current status.
statusReasons	Object Array	An array of reasons that the health plan has given for the current status.
statusReasons.value	String	A description of the status reason.
statusReasons.code	String	A code that represents the status reason.
validationMessages	Object Array	An array of error messages explaining problems with this ServiceReview. Errors encountered during validation at Availity will have a field and possibly an index. Errors returned by the health plan will have a code.
validationMessages.errorMessage	String	A description of the problem.
validationMessages.field	String	The field of the ServiceReview that has the problem.
validationMessages.index	Number*	The index (if applicable) of the item with the field that has the problem.
validationMessages.code	String	A code identifying the error.
certificationIssueDate	Date	The date on which the health plan authorized the service or referral.
certificationEffectiveDate	Date	The date on which the health plan's authorization will take effect.
certificationExpirationDate	Date	The date on which the health plan's authorization will expire.
certificationNumber	String	The authorization number assigned by the health plan to be used on claims.
referenceNumber	String	A reference number assigned by the health plan to pended or otherwise incomplete ServiceReviews.
traceNumbers	String Array	An array of trace numbers that the health plan has assigned to this ServiceReview.
requestType	String	A description type of request (inpatient service, outpatient service, or referral).
requestTypeCode	String	A code respresenting the type of request.
payer	Object	An object representing the health plan of the patient.
payer.id	String	The Availity payer id for the health plan.
payer.name	String	The name of the health plan.
payer.contactName	String	The contact name of the health plan.
payer.phone	String	The phone number of the health plan.
payer.extension	String	The phone number extension of the health plan.
payer.fax	String	The fax number of the health plan.
payer.emailAddress	String	The email address of the health plan.
payer.url	String	The website address of the health plan.
payerNotes	Object Array	An array of notes that the health plan has added to this ServiceReview.
payerNotes.message	String	The text of a note.
requestingProvider	Object	An object representing the provider that is requesting authorization to perform a service or refer a patient.
requestingProvider.lastName	String	The last or business name of the requesting provider.
requestingProvider.firstName	String	The first name of the requesting provider.
requestingProvider.middleName	String	The middle name of the requesting provider.
requestingProvider.suffix	String	The suffix of the requesting provider.
requestingProvider.npi	String	The national provider id of the requesting provider.
requestingProvider.taxId	String	The tax id of the requesting provider.
requestingProvider.payerAssignedProviderId	String	The health plan assigned id of the requesting provider.
requestingProvider.submitterId	String	The submitter id of the requesting provider.
requestingProvider.specialty	String	A description of the specialty of the requesting provider.
requestingProvider.specialtyCode	String	A code that represents the specialty of the requesting provider.
requestingProvider.addressLine1	String	The first line of the address of the requesting provider.
requestingProvider.addressLine2	String	The second line of the address of the requesting provider.
requestingProvider.city	String	The city of the requesting provider.
requestingProvider.state	String	The name of the state of the requesting provider.
requestingProvider.stateCode	String	The code of the state of the requesting provider.
requestingProvider.zipCode	String	The ZIP code of the requesting provider.
requestingProvider.contactName	String	A contact name for the requesting provider.
requestingProvider.phone	String	The phone number of the requesting provider.
requestingProvider.extension	String	The phone extension of the requesting provider.
requestingProvider.fax	String	The fax number of the requesting provider.
requestingProvider.emailAddress	String	The email address of the requesting provider.
requestingProvider.url	String	The website address of the requesting provider.
subscriber	Object	An object representing the health plan subscriber.
subscriber.memberId	String	The member id of the subscriber.
subscriber.lastName	String	The last name of the subscriber.
subscriber.firstName	String	The first name of the subscriber.
subscriber.middleName	String	The middle name of the subscriber.
subscriber.suffix	String	The suffix of the subscriber.
subscriber.addressLine1	String	The first line of the address of the subscriber.
subscriber.addressLine2	String	The second line of the address of the subscriber.
subscriber.city	String	The city of the subscriber.
subscriber.state	String	The name of the state of the subscriber.
subscriber.stateCode	String	The code of the state of the subscriber.
subscriber.zipCode	String	The ZIP code of the subscriber.
patient	Object	An object representing the patient having the service or being referred.
patient.lastName	String	The last name of the patient.
patient.firstName	String	The first name of the patient.
patient.middleName	String	The middle name of the patient.
patient.suffix	String	The suffix of the patient.
patient.subscriberRelationship	String	A description of the patient's relationship to the subscriber.
patient.subscriberRelationshipCode	String	A code representing the patient's relationship to the subscriber.
patient.birthDate	Date	The birth date of the patient.
patient.gender	String	A description of the gender of the patient.
patient.genderCode	String	A code representing the gender of the patient.
patient.addressLine1	String	The first line of the address of the patient.
patient.addressLine2	String	The second line of the address of the patient.
patient.city	String	The city of the patient.
patient.state	String	The name of the state of the patient.
patient.stateCode	String	The code of the state that the patient resides.
patient.zipCode	String	The ZIP code of the patient.
patient.status	String	A description of the status of the patient.
patient.statusCode	String	A code representing the status of the patient.
patient.condition	String	A description of condition of the patient.
patient.conditionCode	String	A code representing the condition of the patient.
patient.medicareCoverage	String	An indicator identifying whether or not this patient has Medicare coverage.
patient.prognosis	String	A description of the prognosis of the patient.
patient.prognosisCode	String	A code representing the prognosis of the patient.
diagnoses	Object Array	An array of diagnoses that are related to the service or referral.
diagnoses.qualifier	String	The description of the qualifier indicating what type of diagnosis code is used.
diagnoses.qualifierCode	String	A code representing the qualifier indicating what type of diagnosis code is used.
diagnoses.value	String	A description of the diagnosis.
diagnoses.code	String	A code representing the diagnosis.
diagnoses.date	Date	The date that the patient was given this diagnosis.
serviceType	String	A description of the type of service to be performed.
serviceTypeCode	String	A code representing the type of service to be performed.
placeOfService	String	A description of the place of service.
placeOfServiceCode	String	A code representing the place of service.
serviceLevel	String	A description of the level of service.
serviceLevelCode	String	A code representing the level of service.
fromDate	Date	The service start date or admission date.
toDate	Date	The service end date or discharge date.
quantity	String	The number of units associated with the service.
quantityType	String	A description of the quantity units.
quantityTypeCode	String	A code representing the quantity units.
admissionType	String	A description of the type of admission on an inpatient authorization request.
admissionTypeCode	String	A code representing the type of admission on an inpatient authorization request.
admissionSource	String	A description of the source of admission on an inpatient authorization request.
admissionSourceCode	String	A code representing the source of admission on an inpatient authorization request.
nursingHomeResidentialStatus	String	A description of the nursing home residential status on an inpatient authorization request.
nursingHomeResidentialStatusCode	String	A code representing the nursing home residential status on an inpatient authorization request.
homeHealthStartDate	Date	The start of home health services for a home health outpatient authorization request.
homeHealthCertificationPeriodStartDate	Date	The start of the home health certification period for a home health outpatient authorization request.
homeHealthCertificationPeriodEndDate	Date	The end of the home health certification period for a home health outpatient authorization request.
transportType	String	A description of the type of transport being performed on a medically related transport outpatient authorization request.
transportTypeCode	String	A code representing the type of transport being performed on a medically related transport outpatient authorization request.
transportDistance	String	The distance the patient will be transported on a medically related transport outpatient authorization request.
transportPurpose	String	The purpose of transporting the patient.
transportLocations	Object Array	An array of locations associated with a medically related transport outpatient authorization request.
transportLocations.name	String	The name of the transport location.
transportLocations.addressLine1	String	Line one of the address of the transport location.
transportLocations.addressLine2	String	Line two of the address of the transport location.
transportLocations.city	String	The city of the transport location.
transportLocations.state	String	The name of the state of the transport location.
transportLocations.stateCode	String	The code of the state of the transport location.
transportLocations.zipCode	String	The ZIP code of the transport location.
renderingProviders	Object Array	An array of providers (that will render the service are being referred to) and facilities (where the service will be performed).
renderingProviders.role	String	A description of the role of this rendering provider.
renderingProviders.roleCode	String	A code representing the role of this rendering provider.
renderingProviders.lastName	String	The last or business name of this rendering provider.
renderingProviders.firstName	String	The first name of this rendering provider.
renderingProviders.middleName	String	The middle name of this rendering provider.
renderingProviders.suffix	String	The suffix of this rendering provider.
renderingProviders.npi	String	The national provider id of this rendering provider.
renderingProviders.taxId	String	The tax id of this rendering provider.
renderingProviders.payerAssignedProviderId	String	The health plan assigned provider id of this rendering provider.
renderingProviders.specialty	String	A description of the specialty of this rendering provider.
renderingProviders.specialtyCode	String	A code representing the specialty of this rendering provider.
renderingProviders.addressLine1	String	The first line of the address of this rendering provider.
renderingProviders.addressLine2	String	The second line of the address of this rendering provider.
renderingProviders.city	String	The city of this rendering provider.
renderingProviders.state	String	The name of the state of this rendering provider.
renderingProviders.stateCode	String	The code of the state of this rendering provider.
renderingProviders.zipCode	String	The ZIP code of this rendering provider.
renderingProviders.contactName	String	A contact name for this rendering provider.
renderingProviders.phone	String	The phone number of this rendering provider.
renderingProviders.extension	String	The phone extension of this rendering provider.
renderingProviders.fax	String	The fax number of this rendering provider.
renderingProviders.emailAddress	String	The email address of this rendering provider.
renderingProviders.url	String	The website address of this rendering provider.
procedures	Object Array	An array of procedures to be performed.
procedures.status	String	A description of the authorization status of this procedure.
procedures.statusCode	String	A code representing the authorization status of this procedure.
procedures.statusReasons	String	An array of reasons the health plan has given for the status of authorization on this procedure.
procedures.statusReasons.value	String	A description of the reason for the status.
procedures.statusReasons.code	String	A code representing the reason for the status.
procedures.certificationIssueDate	Date	The date on which the health plan authorized the procedure.
procedures.certificationEffectiveDate	Date	The date on which the health plan's authorization will take effect.
procedures.certificationExpirationDate	Date	The date on which the health plan's authorization will expire.
procedures.certificationNumber	String	The authorization number assigned by the health plan to be used on claims.
procedures.qualifier	String	A description of the category of procedure code.
procedures.qualifierCode	String	A code representing the category of procedure code.
procedures.value	String	A description of the procedure.
procedures.code	String	A code representing the procedure.
procedures.modifier1	String	A description of the first modifier applied to this procedure.
procedures.modifier1Code	String	A code representing the first modifier applied to this procedure.
procedures.modifier2	String	A description of the second modifier applied to this procedure.
procedures.modifier2Code	String	A code representing the second modifier applied to this procedure.
procedures.modifier3	String	A description of the third modifier applied to this procedure.
procedures.modifier3Code	String	A code representing the third modifier applied to this procedure.
procedures.modifier4	String	A description of the fourth modifier applied to this procedure.
procedures.modifier4Code	String	A code representing the fourth modifier applied to this procedure.
procedures.description	String	A free form description written by the provider describing this procedure.
procedures.quantity	String	The quantity of this procedure to be rendered.
procedures.quantityType	String	A description of the type of quantity.
procedures.quantityTypeCode	String	A code representing the type of quantity.
procedures.fromDate	Date	The start date of the procedure.
procedures.toDate	Date	The end date of procedure.
procedures.payerNotes	Object Array	An array of notes that the health plan has added to this procedure.
procedures.payerNotes.message	String	The text of a note.
procedures.traceNumbers	String Array	An array of trace numbers that the health plan has assigned to this procedure.

SERVICE REVIEW STATUSES

ServiceReview.statusCode	ServiceReview.status	Description
A1	Certified in Total	The health plan has fully authorized the request. The resource will have a certificationNumber that you can use on a claim.
A2	Certified - Partial	The health plan has partially authorized the request. Check the procedures for more details.
A3	Not Certified	The health plan has denied the request. Check the statusReasons for more details.
A6	Modified	The health plan has indicated that the request has been modified. Check back later.
C	Cancelled	The health plan has indicated that the request has been cancelled.
CT	Contact Payer	The health plan has indicated that the requesting provider should contact them. See the health plan object in the resource for contact information.
NA	No Action Required	The health plan has indicated that an authorization is not required for the request.
51	Complete	The health plan has indicated that the request is complete.
71	Term Expired	The health plan has indicated that the term has expired.

POST /V2/SERVICE-REVIEWS

This endpoint creates service reviews asynchronously. To submit a transaction, make a valid request and we will respond with a location header containing a URL you can query for your result.

RESPONSE STATUSES

HTTP Status Code	Description
202	We are currently processing your request.
400	Your request has been rejected. It either failed our validation rules or was rejected by the health plan. The errors property will contain detailed information. Errors that specify a field are Availity validation rule failures. Errors that specify a code are from the health plan.
500	We were unable to parse your request.

VALIDATION RULES

The validation rules for the ServiceReview resource can vary by health plan, the type of authorization being requested, and the type of service to be performed. Availity organizes these rules and makes them available through the Configuration resource. The Configuration resource documents the fields you need to send to create a ServiceReview and explains what values are valid for those fields. See Configurations.

EXAMPLES

If your request is invalid, we will respond with a status code of 400 and a list of errors for you to correct.

	$ curl -i -H "Content-Type: application/json" -X POST -d '{
	  "payer" : {
		"id" : "BCBSF",
	  },
	  "requestingProvider" : {
		"lastName" : "Slice n Dice Discount Surgery"
	  },
	  "subscriber" : {
		"memberId" : "XBH1823812"
	  },
	  "patient" : {
		"lastName" : "Smith",
		"firstName" : "Bob",
		"birthDate" : "1956-01-29",
	  },
	  "diagnoses" : [{
		"qualifierCode" : "ABF",
		"code" : "W5602XA"
	  }],
	  "requestTypeCode" : "AR",
	  "serviceTypeCode" : "1",
	  "placeOfServiceCode" : "11",
	  "fromDate" : "2014-05-01",
	  "toDate" : "2014-05-03",
	  "quantity" : "3",
	  "quantityTypeCode" : "DA",
	  "admissionTypeCode" : "1",
	  "renderingProviders" : [{
		"roleCode" : "71",
		"lastName" : "Jones",
		"firstName" : "Jane",
		"npi" : "1231231238"
	  },{
		"roleCode" : "FA",
		"lastName" : "Slice and Dice Surgery Center",
		"npi" : "1234912380"
	  }],
	  "procedures" : [{
		"qualifierCode" : "HC",
		"code" : "S8948",
		"quantity" : "1",
		"quantityTypeCode" : "UN"
	  }]
	}' https://api.availity.com/availity/v2/service-reviews
	HTTP/1.1 400 Bad Request
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
	  "userMessage": "The request was invalid. See the 'errors' property for details.",
		"developerMessage": "The request was invalid. See the 'errors' property for details.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode": 0,
		"statusCode": 400,
		"errors": [
			{
				"field": "requestingProvider.npi",
				"errorMessage": "Please enter a valid Requesting Provider NPI.",
				"index": 0
			}
		}
	}

If your request is valid, we will respond with a status code of 202 and a location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -i -H "Content-Type: application/json" -X POST -d '{
	  "payer" : {
		"id" : "BCBSF",
	  },
	  "requestingProvider" : {
		"lastName" : "Slice n Dice Discount Surgery",
		"npi" : "1234567893"
	  },
	  "subscriber" : {
		"memberId" : "XBH1823812"
	  },
	  "patient" : {
		"lastName" : "Smith",
		"firstName" : "Bob",
		"birthDate" : "1956-01-29",
	  },
	  "diagnoses" : [{
		"qualifierCode" : "ABF",
		"code" : "W5602XA"
	  }],
	  "requestTypeCode" : "AR",
	  "serviceTypeCode" : "1",
	  "placeOfServiceCode" : "11",
	  "fromDate" : "2014-05-01",
	  "toDate" : "2014-05-03",
	  "quantity" : "3",
	  "quantityTypeCode" : "DA",
	  "admissionTypeCode" : "1",
	  "renderingProviders" : [{
		"roleCode" : "71",
		"lastName" : "Jones",
		"firstName" : "Jane",
		"npi" : "1231231238"
	  },{
		"roleCode" : "FA",
		"lastName" : "Slice and Dice Surgery Center",
		"npi" : "1234912380"
	  }],
	  "procedures" : [{
		"qualifierCode" : "HC",
		"code" : "S8948",
		"quantity" : "1",
		"quantityTypeCode" : "UN"
	  }]
	}' https://api.availity.com/availity/v2/service-reviews
	->
	HTTP/1.1 202 Accepted
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	Location: https://api.availity.com/availity/v2/service-reviews/-11923818311
	X-Status-Message: We are processing your request.

GET /V2/SERVICE-REVIEWS/:ID

You can retrieve a service review using this endpoint.

RESPONSE STATUSES

HTTP Status Code	Description
200	We are done processing your request and the response body contains the result.
202	We are currently processing your request. We may be retrying it. The X-Status-Message header will contain additional detail.
404	We did not find a ServiceReview with the id that you sent.
504	We were unable to process your request. The health plan did not respond after several retry attempts. Please try your request again later.

EXAMPLES

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v2/service-reviews/-11923818311
	->
	HTTP/1.1 200 OK
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"id" : "-11923818311",
		"createdDate" : "2014-04-28T21:59:29.000+0000",
		"updatedDate" : "2014-04-29T08:28:01.000+0000",
		"expirationDate" : "2014-05-14T21:59:29.000+0000",
		"customerId" : "11314",
		"updatable" : false,
		"status" : "Certified in Total",
		"statusCode" : "A1",
		"certificationIssueDate" : "2014-04-29",
		"certificationEffectiveDate" : "2014-05-01",
		"certificationExpirationDate" : "2014-05-03",
		"certificationNumber" : "129738127",
		"payer" : {
			"id" : "BCBSF",
			"name" : "Florida Blue",
			"contactName" : "Billing Dept",
			"phone" : "1-800-555-4444"
		},
		"requestingProvider" : {
			"lastName" : "Slice n Dice Discount Surgery",
			"npi" : "1234567893"
		},
		"subscriber" : {
			"memberId" : "XBH1823812"
		},
		"patient" : {
			"lastName" : "Smith",
			"firstName" : "Bob",
			"birthDate" : "1956-01-29",
			"subscriberRelationship" : "Self",
			"subscriberRelationshipCode" : "18"
		},
		"diagnoses" : [{
			"qualifier" : "ICD-10",
			"qualifierCode" : "ABF",
			"value" : "Struck by dolphin, initial encounter",
			"code" : "W5602XA"
		}],
		"requestType" : "Admission Review",
		"requestTypeCode" : "AR",
		"serviceType" : "Medical Care",
		"serviceTypeCode" : "1",
		"placeOfService" : "Office",
		"placeOfServiceCode" : "11",
		"fromDate" : "2014-05-01",
		"toDate" : "2014-05-03",
		"quantity" : "3",
		"quantityType" : "Days",
		"quantityTypeCode" : "DA",
		"admissionType" : "Emergency",
		"admissionTypeCode" : "1",
		"renderingProviders" : [{
			"role" : "Attending Provider",
			"roleCode" : "71",
			"lastName" : "Jones",
			"firstName" : "Jane",
			"npi" : "1231231238"
		},{
			"role" : "Facility",
			"roleCode" : "FA",
			"lastName" : "Slice and Dice Surgery Center",
			"npi" : "1234912380"
		}],
		"procedures" : [{
			"qualifier" : "HCPCS",
			"qualifierCode" : "HC",
			"value" : "Low-level laser treatment, 15 minutes",
			"code" : "S8948",
			"quantity" : "1",
			"quantityType" : "Units",
			"quantityTypeCode" : "UN"
		}]
	}

GET /V2/SERVICE-REVIEWS

You can search the for service reviews in the health plan's system using this endpoint.

This endpoint queries the health plan's system asynchronously. To submit a transaction, make a valid request and we will respond with a location header containing a URL you can query for your result.

Parameter	Type	Description
payer.id	String	The Availity payer id of the health plan.
requestingProvider.specialtyCode	String	The specialty code of the requesting provider.
requestingProvider.lastName	String	The last or business name of the requesting provider.
requestingProvider.firstName	String	The first name of the requesting provider.
requestingProvider.middleName	String	The middle name of the requesting provider.
requestingProvider.suffix	String	The suffix of the requesting provider.
requestingProvider.npi	String	The NPI of the requesting provider.
requestingProvider.taxId	String	The tax id of the requesting provider.
requestingProvider.payerAssignedProviderId	String	The payer assigned provider id of the requesting provider.
requestingProvider.submitterId	String	The submitter id of the requesting provider.
requestingProvider.addressLine1	String	Line one of the address of the requesting provider.
requestingProvider.addressLine2	String	Line two of the address of the requesting provider.
requestingProvider.city	String	The city of the requesting provider.
requestingProvider.stateCode	String	The state code of the requesting provider.
requestingProvider.zipCode	String	The ZIP code of the requesting provider.
requestingProvider.contactName	String	The contact name of the requesting provider.
requestingProvider.phone	String	The phone number of the requesting provider.
requestingProvider.extension	String	The phone extension of the requesting provider.
requestingProvider.fax	String	The fax number of the requesting provider.
subscriber.memberId	String	The member id of the subscriber.
subscriber.firstName	String	The first name of the subscriber.
subscriber.lastName	String	The last name of the subscriber.
subscriber.middleName	String	The middle name of the subscriber.
subscriber.suffix	String	The suffix of the subscriber.
patient.lastName	String	The last name of the patient.
patient.firstName	String	The first name of the patient.
patient.middleName	String	The middle name of the patient.
patient.suffix	String	The suffix of the patient.
patient.birthDate	Date	The birth date of the patient.
patient.subscriberRelationshipCode	String	The code of the patient's relationship to the subscriber.
requestTypeCode	String	The type code of service reviews you would like to query for.
fromDate	Date	The service from date.
toDate	Date	The service to date.
certificationIssueDate	Date	The date the service review certification was issued.
certificationNumber	String	The number assigned to certified service reviews.
referenceNumber	String	The number assigned to uncertified service reviews.
statusCode	String	The status code of the service reviews.
sessionId	String	Used for polling for a result.

RESPONSE STATUSES

HTTP Status Code	Description
200	We are done processing your request and the response body contains the result.
202	We are currently processing your request. We may be retrying it. The X-Status-Message header will contain additional detail.
400	Your request has been rejected. It either failed our validation rules or was rejected by the health plan. The errors property will contain detailed information. Errors that specify a field are Availity validation rule failures. Errors that specify a code are from the health plan.
504	We were unable to process your request. The health plan did not respond after several retry attempts. Please try your request again later.

VALIDATION RULES

The validation rules for the ServiceReview resource can vary by health plan, the type of authorization being requested, and the type of service to be performed. Availity organizes these rules and makes them available through the Configuration resource. The Configuration resource documents the fields you need to send to create a ServiceReview and explains what values are valid for those fields. See Configurations.

EXAMPLES

If your request is invalid, we will respond with a status code of 400 and a list of errors for you to correct.

	$ curl -i -X GET -i https://api.availity.com/availity/v2/service-reviews?requestTypeCode=AR&requestingProviderLastName=SLICE N DICE DISCOUNT SURGERY&requestingProviderAddressLine1=123Street&requestingProviderCity=Jacksonville&requestingProviderState=FL&requestingProviderZipCode=123451234&requestingProviderContactName=John&requestingProviderPhone=1112223333&memberId=TEST1&patientLastName=Doe&patientFirstName=John&patientBirthDate=1990-01-01&fromDate=2015-01-01
	->
	HTTP/1.1 400 Bad Request
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"userMessage": "The request was invalid. See the 'errors' property for details.",
		"developerMessage": "The request was invalid. See the 'errors' property for details.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode": 0,
		"statusCode": 400,
		"errors": [
			{
				"field": "requestingProvider.npi",
				"errorMessage": "Please enter a valid Requesting Provider NPI.",
				"index": 0
			}
		}
	}

If your request is valid, we will respond with a status code of 202 and a location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -i -X GET -i https://api.availity.com/availity/v2/service-reviews?requestTypeCode=AR&requestingProviderLastName=SLICE N DICE DISCOUNT SURGERY&requestingProviderAddressLine1=123Street&requestingProviderCity=Jacksonville&requestingProviderState=FL&requestingProviderZipCode=123451234&requestingProviderContactName=John&requestingProviderPhone=1112223333&memberId=TEST1&patientLastName=Doe&patientFirstName=John&patientBirthDate=1990-01-01&fromDate=2015-01-01&requestingProviderNpi=1234567893
	->
	HTTP/1.1 202 Accepted
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	Location: https://api.availity.com/availity/v2/service-reviews?sessionId=-1283121411
	X-Status-Message: We are processing your request.

If the health plan responds with validation messages indicating that they were unable to fulfill your request, we will respond with a status code of 400 and a list of errors from the health plan.

	$ curl -i -X GET -i https://api.availity.com/availity/v2/service-reviews?sessionId=-1283121411
	->
	HTTP/1.1 400 Bad Request
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"userMessage": "The request was invalid. See the 'errors' property for details.",
		"developerMessage": "The request was invalid. See the 'errors' property for details.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode": 0,
		"statusCode": 400,
		"errors": [
			{
				"code": "67",
				"errorMessage": "Patient Not Found - Please Correct and Resubmit"
			}
		}
	}

If we are unable to communicate with the health plan (due to maintenance), we will respond with a status code of 504 and a message indicating that the health plan is down for maintenance.

	$ curl -i -X GET -i https://api.availity.com/availity/v2/service-reviews?sessionId=-1283121411
	->
	HTTP/1.1 504 Gateway Timeout
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"userMessage":"The health plan is down for maintenance.",
		"developerMessage":"We were unable to complete a transaction with the payer.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode":7,
		"statusCode":504
	}

Once the health plan has successfully fulfilled your inquiry request, we will respond with a status code of 200 and summaries of each service review we found.

	$ curl -i -X GET -i https://api.availity.com/availity/v2/service-reviews?sessionId=-1283121411
	->
	HTTP/1.1 200 OK
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	{
		"totalCount" : 2,
		"count" : 2,
		"offset" : 0,
		"limit" : 50,
		"links" : {
			"self" : {
				"href" : "https://api.availity.com/availity/v2/service-reviews?requestTypeCode=AR&requestingProviderLastName=SLICE N DICE DISCOUNT SURGERY&requestingProviderAddressLine1=123Street&requestingProviderCity=Jacksonville&requestingProviderState=FL&requestingProviderZipCode=123451234&requestingProviderContactName=John&requestingProviderPhone=1112223333&memberId=TEST1&patientLastName=Doe&patientFirstName=John&patientBirthDate=1990-01-01&fromDate=2015-01-01&requestingProviderNpi=1234567893"
			}
		},
		"serviceReviews" : [{
		  "links" : {
			"self" : {
			  "href" : "https://api.availity.com/availity/v2/service-reviews/111231"
			}
		  },
		  "id" : "111231",
		  "status" : "Pended",
		  "statusCode" : "A4",
		  "createdDate" : "2015-01-21T17:44:46.000+0000",
		  "updatedDate" : "2015-01-22T17:44:52.000+0000",
		  "expirationDate" : "2015-02-15T17:44:46.000+0000",
		  "updatable" : false,
		  "referenceNumber" : "REF12345",
		  "payer" : {
			  "name" : "FLORIDA BLUE",
			  "id" : "BCBSF"
		  },
		  "requestingProvider" : {
			  "lastName" : "SLICE AND DICE DISCOUNT SURGERY",
			  "npi" : "1234567893",
		  },
		  "subscriber" : {
			  "firstName" : "BRUCE",
			  "lastName" : "WAYNE",
			  "memberId" : "ASDF123124",
		  },
		  "patient" : {
			  "firstName" : "BRUCE",
			  "lastName" : "WAYNE",
			  "subscriberRelationship" : "Self",
			  "subscriberRelationshipCode" : "18",
			  "birthDate" : "1962-08-10",
		  },
		  "requestType" : "Admission Review",
		  "requestTypeCode" : "AR",
		  "serviceType" : "Medical Care",
		  "serviceTypeCode" : "1",
		  "fromDate" : "2015-01-22",
		  "toDate" : "2015-01-25"
		},{
		  "links" : {
			"self" : {
			  "href" : "https://api.availity.com/availity/v2/service-reviews/111221"
			}
		  },
		  "id" : "111221",
		  "status" : "Certified in Total",
		  "statusCode" : "A1",
		  "createdDate" : "2015-01-25T17:44:46.000+0000",
		  "updatedDate" : "2015-01-25T17:44:52.000+0000",
		  "expirationDate" : "2015-02-17T17:44:46.000+0000",
		  "updatable" : false,
		  "certificationNumber" : "1231723",
		  "payer" : {
			  "name" : "FLORIDA BLUE",
			  "id" : "BCBSF"
		  },
		  "requestingProvider" : {
			  "lastName" : "SLICE AND DICE DISCOUNT SURGERY",
			  "npi" : "1234567893",
		  },
		  "subscriber" : {
			  "firstName" : "FRED",
			  "lastName" : "FLINTSTONE",
			  "memberId" : "ASDF23123123"
		  },
		  "patient" : {
			  "firstName" : "WILMA",
			  "lastName" : "FLINTSTONE",
			  "subscriberRelationship" : "Spouse",
			  "subscriberRelationshipCode" : "01",
			  "birthDate" : "1961-01-15"
		  },
		  "requestType" : "Admission Review",
		  "requestTypeCode" : "AR",
		  "serviceType" : "Medical Care",
		  "serviceTypeCode" : "1",
		  "fromDate" : "2015-01-26",
		  "toDate" : "2015-01-27"
		}]
	}

PUT /V2/SERVICE-REVIEWS

This endpoint updates service reviews asynchronously. Only a service review with updatable=true can be updated. Once you make a valid request, we will respond with a location header containing a URL you can query for your result while we asynchronously send an updated copy of the service review to the health plan.

RESPONSE STATUSES

HTTP Status Code	Description
202	We are currently processing your request.
400	Your request has been rejected. It either failed our validation rules (a 400 in res) See the errors property for details.
404	We did not find a ServiceReview with the id that you sent.
500	We were unable to parse your request.

EXAMPLES

	$ curl -i -H "Content-Type: application/json" -X PUT -d '{
	  "links" : {
		"self" : {
		  "href" : "https://api.availity.com/availity/v2/service-reviews/-11923818311"
		}
	  },
	  "id" : "-11923818311",
	  "payer" : {
		"id" : "BCBSF",
		"name" : "Florida Blue"
	  },
	  "requestingProvider" : {
		"lastName" : "Slice n Dice Discount Surgery",
		"npi" : "1234567893"
	  },
	  "subscriber" : {
		"memberId" : "XBH1823812"
	  },
	  "patient" : {
		"lastName" : "Smith",
		"firstName" : "Bob",
		"birthDate" : "1956-01-29",
		"subscriberRelationshipCode" : "18"
	  },
	  "diagnoses" : [{
		"qualifierCode" : "ABF",
		"code" : "W5602XA"
	  }],
	  "requestTypeCode" : "AR",
	  "serviceTypeCode" : "1",
	  "placeOfServiceCode" : "11",
	  "fromDate" : "2014-05-01",
	  "toDate" : "2014-05-03",
	  "quantity" : "3",
	  "quantityTypeCode" : "DA",
	  "admissionTypeCode" : "1",
	  "renderingProviders" : [{
		"roleCode" : "71",
		"lastName" : "Jones",
		"firstName" : "Jane",
		"npi" : "1231231238"
	  },{
		"roleCode" : "FA",
		"lastName" : "Slice and Dice Surgery Center",
		"npi" : "1234912380"
	  }],
	  "procedures" : [{
		"qualifierCode" : "HC",
		"code" : "S8948",
		"quantity" : "1",
		"quantityTypeCode" : "UN"
	  }]
	}' https://api.availity.com/availity/v2/service-reviews
	->
	HTTP/1.1 202 Accepted
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	Location: https://api.availity.com/availity/v2/service-reviews/-11923818311
	X-Status-Message: We are processing your request.

UPDATABILITY

The ServiceReview resource contains a flag called updatable that indicates whether or not it can be updated. Availity does not allow you to update ServiceReviews that are currently in progress (being processed in our system). Furthermore, health plans can indicate whether or not a ServiceReview is updatable and, if so, which fields can be changed. This can differ from one ServiceReview to another and can change over the life span of a ServiceReview.

In all ServiceReviews that have an updatable property of true, you will find an updatableFields collection (ServiceReview.updatableFields). The health plan determines which fields are updatable for each service review. You will find the fields they have marked as updatable in this collection.

DELETE /V2/SERVICE-REVIEWS/:ID

This endpoint voids an existing service review asynchronously. Only a service review with deleteable=true can be voided. Once you make a valid request, we will respond with a location header containing a URL you can query for your result while we asynchronously send a void request to the health plan.

RESPONSE STATUSES

HTTP Status Code	Description
202	We are currently processing your request.
400	Your request has been rejected.
404	We did not find a ServiceReview with the id that you sent.
500	We were unable to parse your request.

EXAMPLES

	$ curl -i -H "Content-Type: application/json" -X DELETE https://api.availity.com/availity/v2/service-reviews/-11923818311
	->
	HTTP/1.1 202 Accepted
	x-api-id: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Session-ID: a8380404-0d07-47fa-9e86-44eee35a02bb
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Thu, 26 Feb 2015 05:10:26 GMT
	X-Global-Transaction-ID: 36774789
	Connection: close
	Location: https://api.availity.com/availity/v2/service-reviews/-11923818311
	X-Status-Message: We are processing your request.

DELETABILITY

The ServiceReview resource contains a flag called deletable that indicates whether or not it can be deleted. Availity does not allow you to dlete ServiceReviews that are currently in progress (being processed in our system). Furthermore, health plans can indicate whether or not a ServiceReview is deletable. This can differ from one ServiceReview to another and can change over the life span of a ServiceReview.

Claim Statuses

This resource represents a request and response for claim status information from a health plan. Your application can use the endpoints defined for it to find, create, and manage these requests.

The Resource

Field	Type	Description
id	String	A unique identifier that Availity has assigned to this ClaimStatus.
createdDate	TimeStamp	The date and time when this item was created in Availity's system.
updatedDate	TimeStamp	The date and time when this item was last updated.
expirationDate	TimeStamp	The date and time when this item will be removed from Availity's system.
customerId	String	The id of the Availity customer that owns this ClaimStatus. Availity may ask for this during support calls.
controlNumber	String	The id of the last transaction associated with this ClaimStatus. The health plan may ask for this during support calls.
status	String	A description of the current status of this ClaimStatus.
statusCode	String	A code that represents the current status.
fromDate	Date	The from date specified in the initial claim status inquiry request.
toDate	Date	The to date specified in the initial claim status inquiry request.
claimNumber	String	The health plan's claim tracking number assigned when the original claim was received and processed.
claimAmount	String	The total claim charge amount of the original claim processed by the health plan.
facilityTypeCode	String	The code identifying where services were, or may have been, performed for institutional claims.
facilityType	String	A description of the facility type.
frequencyTypeCode	String	The code identifying the frequency of an institutional claim.
frequencyType	String	A description of the frequency type.
payer	Object	An object representing the health plan of the patient.
payer.id	String	The Availity id of the health plan.
payer.name	String	The name of the health plan.
payer.contactName	String	The contact name of the health plan.
payer.phone	String	The phone number of the health plan.
payer.extension	String	The phone number extension of the health plan.
payer.fax	String	The fax number of the health plan.
payer.emailAddress	String	The email address of the health plan.
payer.ediAccessNumber	String	The electronic data interchange access Number or the health plan.
submitter	Object	An object representing the organization or person that is requesting/submitting the claim status.
submitter.lastName	String	The last or business name of the submitter.
submitter.firstName	String	The first name of the submitter.
submitter.middleName	String	The middle name of the submitter.
submitter.suffix	String	The suffix of the submitter.
submitter.id	String	The identifier of the submitter.
submitter.traceId	String	A reference id assigned by the health plan to uniquely identify the transaction.
submitter.statusDetails	Object Array	An array of status information reported for the submitter.
submitter.statusDetails.category	String	A description of the logical groupings of claim status codes.
submitter.statusDetails.categoryCode	String	An identifier used to specify the logical groupings of claim status codes.
submitter.statusDetails.status	String	A description of the status associated with a claim or service line.
submitter.statusDetails.statusCode	String	An identifier of the status associated with a claim or service line.
submitter.statusDetails.entity	String	A description of the entity associated with the claim status code.
submitter.statusDetails.entityCode	String	An identifier of the entity associated with the claim status code.
submitter.statusDetails.effectiveDate	Date	The effective date of the status information.
providers	Object Array	An array containing information regarding the provider of services from the original claim.
providers.lastName	String	The last or business name of the service provider.
providers.firstName	String	The first name of the service provider.
providers.middleName	String	The middle name of the service provider.
providers.suffix	String	The suffix of the service provider.
providers.npi	String	The national provider id of the service provider.
providers.taxId	String	The tax id of the service provider.
providers.payerAssignedProviderId	String	The health plan assigned id for the service provider.
providers.traceId	String	A reference id assigned by the health plan to uniquely identify the transaction.
providers.statusDetails	Object Array	An array of status information reported for the provider associated with the original claim.
providers.statusDetails.category	String	A description of the logical groupings of claim status codes.
providers.statusDetails.categoryCode	String	An identifier used to specify the logical groupings of claim status codes.
providers.statusDetails.status	String	A description of the status associated with a claim or service line.
providers.statusDetails.statusCode	String	An identifier of the status associated with a claim or service line.
providers.statusDetails.entity	String	A description of the entity associated with the claim status code.
providers.statusDetails.entityCode	String	An identifier of the entity associated with the claim status code.
providers.statusDetails.effectiveDate	Date	The effective date of the status information.
subscriber	Object	An object representing the health plan subscriber.
subscriber.lastName	String	The last name of the subscriber.
subscriber.firstName	String	The first name of the subscriber.
subscriber.middleName	String	The middle name of the subscriber.
subscriber.suffix	String	The suffix of the subscriber.
subscriber.memberId	String	The member id of the subscriber.
subscriber.taxId	String	The tax id of the subscriber.
patient	Object	An object representing the patient for which the original claim was filed.
patient.lastName	String	The last name of the patient.
patient.firstName	String	The first name of the patient.
patient.middleName	String	The middle name of the patient.
patient.suffix	String	The suffix of the patient.
patient.birthDate	Date	The birth date of the patient.
patient.gender	String	A description of the gender of the patient.
patient.genderCode	String	A code representing the gender of the patient.
patient.accountNumber	String	A reference identifier for the patient assigned by the service provider.
patient.subscriberRelationship	String	A description of the patient's relationship to the subscriber.
patient.subscriberRelationshipCode	String	A code representing the patient's relationship to the subscriber.
claimStatuses	Object Array	An array of claim status information returned from the health plan.
claimStatuses.traceId	String	A reference id assigned by the health plan to uniquely identify this claim status.
claimStatuses.claimControlNumber	String	A unique identifier of the originally submitted/processed claim assigned by the health plan.
claimStatuses.facilityTypeCode	String	The code identifying where services were, or may have been, performed for institutional claims.
claimStatuses.facilityType	String	A description of the facility type.
claimStatuses.frequencyTypeCode	String	The code identifying the frequency of an institutional claim.
claimStatuses.frequencyType	String	A description of the frequency type.
claimStatuses.patientControlNumber	String	A reference identifier for the patient assigned by the service provider that was included on the original claim.
claimStatuses.pharmacyPrescriptionNumber	String	The pharmacy prescription number from the original claim.
claimStatuses.voucherNumber	String	The voucher number returned from the health plan.
claimStatuses.claimIdentificationNumber	String	An identifier of the originally submitted claim assigned by a clearinghouse or intermediary.
claimStatuses.fromDate	Date	The date on which the service began.
claimStatuses.toDate	Date	The date on which the service ended.
claimStatuses.statusDetails	Object Array	An array of status information reported for the original claim.
claimStatuses.statusDetails.category	String	A description of the logical groupings of claim status codes.
claimStatuses.statusDetails.categoryCode	String	An identifier used to specify the logical groupings of claim status codes.
claimStatuses.statusDetails.status	String	A description of the status associated with a claim or service line.
claimStatuses.statusDetails.statusCode	String	An identifier of the status associated with a claim or service line.
claimStatuses.statusDetails.entity	String	A description of the entity associated with the claim status code.
claimStatuses.statusDetails.entityCode	String	An identifier of the entity associated with the claim status code.
claimStatuses.statusDetails.effectiveDate	Date	The effective date of the status information.
claimStatuses.statusDetails.claimAmount	String	The amount of the originally submitted claim charges.
claimStatuses.statusDetails.claimAmountUnits	String	The units of the claim amount. (USD)
claimStatuses.statusDetails.paymentAmount	String	The amount payed by the health plan on the originally submitted claim.
claimStatuses.statusDetails.paymentAmountUnits	String	The units of claim payment amount. (USD)
claimStatuses.statusDetails.finalizedDate	Date	The date the original claim was paid.
claimStatuses.statusDetails.remittanceDate	Date	The date the payment check was issued.
claimStatuses.statusDetails.checkNumber	String	The number of the check that paid the claim paid amount.
claimStatuses.serviceLines	Object Array	An array of service line information from the originally submitted/processed claim.
claimStatuses.serviceLines.procedureQualifier	String	A description of the type or source of the procedure code.
claimStatuses.serviceLines.procedureQualifierCode	String	A code that identifies the type or source of the procedure code.
claimStatuses.serviceLines.procedure	String	A description of the procedure performed from the originally submitted claim.
claimStatuses.serviceLines.procedureCode	String	A code respresenting the procedure performed from the originally submitted claim.
claimStatuses.serviceLines.modifier1	String	A description of the first modifier applied to this procedure.
claimStatuses.serviceLines.modifier1Code	String	A code representing the first modifier applied to this procedure.
claimStatuses.serviceLines.modifier2	String	A description of the second modifier applied to this procedure.
claimStatuses.serviceLines.modifier2Code	String	A code representing the second modifier applied to this procedure.
claimStatuses.serviceLines.modifier3	String	A description of the third modifier applied to this procedure.
claimStatuses.serviceLines.modifier3Code	String	A code representing the third modifier applied to this procedure.
claimStatuses.serviceLines.modifier4	String	A description of the fourth modifier applied to this procedure.
claimStatuses.serviceLines.modifier4Code	String	A code representing the fourth modifier applied to this procedure.
claimStatuses.serviceLines.chargeAmount	String	The amount of the originally submitted charges for the service.
claimStatuses.serviceLines.chargeAmountUnits	String	The units of the service line charge amount. (USD)
claimStatuses.serviceLines.paymentAmount	String	The amount payed by the health plan for the servcie.
claimStatuses.serviceLines.paymentAmountUnits	String	The units of the service payment amount. (USD)
claimStatuses.serviceLines.service	String	A description of the product or service performed reported in this service line.
claimStatuses.serviceLines.serviceCode	String	An identifier of the product or service performed reported in this service line.
claimStatuses.serviceLines.quantity	String	The originally submitted units of service.
claimStatuses.serviceLines.controlNumber	String	A reference identifier for the service assigned by the health plan.
claimStatuses.serviceLines.fromDate	Date	The date on which the service began.
claimStatuses.serviceLines.toDate	Date	The date on which the service ended.
claimStatuses.serviceLines.statusDetails	Object Array	An array of status information reported for the service line of the original claim.
claimStatuses.serviceLines.statusDetails.category	String	A description of the logical groupings of claim status codes.
claimStatuses.serviceLines.statusDetails.categoryCode	String	An identifier used to specify the logical groupings of claim status codes.
claimStatuses.serviceLines.statusDetails.status	String	A description of the status associated with a claim or service line.
claimStatuses.serviceLines.statusDetails.statusCode	String	An identifier of the status associated with a claim or service line.
claimStatuses.serviceLines.statusDetails.entity	String	A description of the entity associated with the claim status code.
claimStatuses.serviceLines.statusDetails.entityCode	String	An identifier of the entity associated with the claim status code.
claimStatuses.serviceLines.statusDetails.effectiveDate	Date	The effective date of the status information.
claimCount	String	The total number of unique claims reported by this claim status inquiry.

Statuses

ClaimStatus.statusCode	ClaimStatus.status	Description
0	In Progress	Availity is communicating with the health plan. Check back in a few seconds.
19	Request Error	The health plan indicated that something is wrong with the request. The resource will have a list of validationMessages. Correct and update the resource.
R1	Communication Error, Retrying	The health plan did not respond. Availity will retry the request over the next 30 minutes.
7	Communication Error, Retries Exhausted	The health plan did not respond after multiple retries. Please resubmit the request later.
3	Complete (Invalid Response)	Availity has received a response from the health plan but it contained errors that may or may not affect the data returned in the asset.
4	Complete	Availity has received a response from the health plan and it is now available for viewing.

GET /V1/CLAIM-STATUSES

You can search the collection of claim statuses using this endpoint.

Parameter	Type	Description
payer.id	String	The Availity id for the health plan.
submitter.lastName	String	The last or business name of the submitter.
submitter.firstName	String	The first name of the submitter.
submitter.middleName	String	The middle name of the submitter.
submitter.suffix	String	The suffix of the submitter.
submitter.id	String	The identifier of the submitter.
providers.lastName	String	The last or business name of the service provider.
providers.firstName	String	The first name of the service provider.
providers.middleName	String	The middle name of the service provider.
providers.suffix	String	The suffix of the service provider.
providers.npi	String	The national provider id of the service provider.
providers.taxId	String	The tax id of the service provider.
providers.payerAssignedProviderId	String	The health plan assigned id for the service provider.
subscriber.memberId	String	The member id of the subscriber.
subscriber.lastName	String	The last name of the subscriber.
subscriber.firstName	String	The first name of the subscriber.
subscriber.middleName	String	The middle name of the subscriber.
subscriber.suffix	String	The suffix of the subscriber.
patient.lastName	String	The last name of the patient.
patient.firstName	String	The first name of the patient.
patient.middleName	String	The middle name of the patient.
patient.suffix	String	The suffix of the patient.
patient.birthDate	Date	The birth date of the patient.
patient.genderCode	String	A code representing the gender of the patient.
patient.accountNumber	String	A reference identifier for the patient assigned by the service provider.
patient.subscriberRelationshipCode	String	A code representing the patient's relationship to the subscriber.
fromDate	Date	The service from date.
toDate	Date	The service to date.
claimNumber	String	The health plan's claim tracking number assigned when the original claim was received and processed.
claimAmount	String	The total claim charge amount of the original claim processed by the health plan.
facilityTypeCode	String	The code identifying where services were, or may have been, performed for institutional claims.
frequencyTypeCode	String	The code identifying the frequency of an institutional claim.
q	String	Fuzzy search parameter - triggers us to search our database instead of reaching out to the health plan.
sortBy	String	Field we will sort by when returning results from our database. Currently only supports - updatedDate.
sortDirection	String	The direction we will sort results from our database. Supports asc and desc. Defaults to desc.
id	String	Allows you to retrive summaries of multiple claim statuses by specifying the id of each.

The endpoint returns summary versions of the claim status resource. Here is an example with all possible fields shown:

	{
		"links": {
			"self": {
				"href": "https://api.availity.com/demo/v1/claim-statuses/-1437397854912689422"
			}
		},
		"id": "-1437397854912689422",
		"customerId": "1194",
		"userId": "aka71627884343",
		"status": "Complete",
		"statusCode": "0",
		"createdDate": "2015-06-05T17:47:23.000+0000",
		"updatedDate": "2015-06-05T17:47:23.000+0000",
		"expirationDate": "2015-06-06T17:47:23.000+0000",
		"fromDate": "2015-05-15T04:00:00.000+0000",
		"toDate": "2015-05-19T04:00:00.000+0000",
		"claimNumber": "CL4IM2TATUSNUM8ER",
		"claimAmount": "12345678.90",
		"facilityTypeCode": "12",
		"facilityType": "Hospital Inpatient, Part B only",
		"frequencyTypeCode": "1",
		"frequencyType": "Admit thru Discharge Claim",
		"claimCount": "1"
		"payer": {
			"id": "BCBSF",
			"name" : "FLORIDA BLUE"
		},
		"submitter": {
			"lastName": "SUBMITTERLASTNAME",
			"firstName": "SUBMITTERFIRSTNAME",
			"middleName": "SUBMITTERMIDDLENAME",
			"suffix": "SUBMITTERSUFFIX",
			"id": "SUBMITTERID"
		},
		"providers": [
			{
				"lastName": "PROVIDERLASTNAME",
				"firstName": "PROVIDERFIRSTNAME",
				"middleName": "PROVIDERMIDDLENAME",
				"suffix": "PROVIDERSUFFIX",
				"npi": "1234567893"
				"taxId": "1234567893"
				"payerAssignedProviderId": "1234567893"
			}
		],
		"subscriber": {
			"firstName": "SUBSCRIBERFIRSTNAME",
			"lastName": "SUBSCRIBERLASTNAME",
			"middleName": "SUBSCRIBERMIDDLENAME",
			"suffix": "SUBSCRIBERSUFFIX",
			"memberId": "ABC123456789"
		},
		"patient": {
			"firstName": "PATIENTFIRSTNAME",
			"lastName": "PATIENTLASTNAME",
			"middleName": "PATIENTMIDDLENAME",
			"suffix": "PATIENTSUFFIX",
			"birthDate": "1999-09-09",
			"gender": "Male",
			"genderCode": "M",
			"accountNumber": "PAT1ENTACC0UNTNUMB3R",
			"subscriberRelationship": "Spouse",
			"subscriberRelationshipCode": "01"
		}
	}

Multi-summary Mode

The first way to interact with the endpoint is called multi-summary mode. It allows you to retrieve summary versions and check the status of multiple claim statuses at once. You can initiate it by specifying one or more id parameters where each id is the id of a claim status you are interested in. Any other parameters will be ignored. You can get up to 50 claim status summaries at a time using this feature. Here is an example of getting two summaries by id:

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?id=-6444806312330895858&id=-1437397854912689422
	->
	HTTP/1.1 200 OK
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	{
		"totalCount": 2,
		"count": 2,
		"offset": 0,
		"limit": 50,
		"links": {
			"self": {
				"href": "https://api.availity.com/demo/v1/claim-statuses?id=-6444806312330895858&id=-1437397854912689422"
			}
		},
		"claimStatuses": [
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/-6444806312330895858"
					}
				},
				"id": "-6444806312330895858",
				"customerId": "1194",
				"controlNumber": "36374",
				"userId": "aka71627884343",
				"status": "Complete",
				"statusCode": "4",
				"createdDate": "2015-06-05T17:50:30.000+0000",
				"updatedDate": "2015-06-05T17:50:30.000+0000",
				"expirationDate": "2015-06-06T17:50:30.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "12345678.90",
				"facilityTypeCode": "12",
				"facilityType": "Hospital Inpatient, Part B only",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTERID"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "TEST",
					"middleName": "B",
					"lastName": "PATIENT",
					"suffix": "III",
					"memberId": "BEAH276TESTGEN"
				},
				"patient": {
					"firstName": "TEST",
					"middleName": "B",
					"lastName": "PATIENT",
					"suffix": "III",
					"birthDate": "1999-09-09",
					"gender": "Male",
					"genderCode": "M",
					"accountNumber": "UNKNOWN",
					"subscriberRelationship": "Self",
					"subscriberRelationshipCode": "18"
				},
				"claimCount": "1"
			},
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/-1437397854912689422"
					}
				},
				"id": "-1437397854912689422",
				"customerId": "1194",
				"controlNumber": "36373",
				"userId": "aka71627884343",
				"status": "Complete (Invalid Response)",
				"statusCode": "3",
				"createdDate": "2015-06-05T17:47:23.000+0000",
				"updatedDate": "2015-06-05T17:47:23.000+0000",
				"expirationDate": "2015-06-06T17:47:23.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "12345678.90",
				"facilityTypeCode": "12",
				"facilityType": "Hospital Inpatient, Part B only",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTERID"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"memberId": "ABC123456789"
				},
				"patient": {
					"firstName": "PATIENTFIRSTNAME",
					"lastName": "PATIENTLASTNAME",
					"birthDate": "1999-09-09",
					"gender": "Male",
					"genderCode": "M",
					"accountNumber": "PAT1ENTACC0UNTNUMB3R",
					"subscriberRelationship": "Unknown",
					"subscriberRelationshipCode": "21"
				},
				"claimCount": "1"
			}
		}]
	}

Search Mode

The second way to interact with the endpoint is called search mode. It allows you to search the claim statuses that are in Availity's database. This mode is useful for building searchable list views of claim statuses. You initiate it by sending a q parameter (even a blank one). We will use this parameter to perform a fuzzy search in our database. In addition, you can perform case insensitive filtering by sending any of the other parameters (except id). Furthermore, this mode supports sorting and paging. Here is an example:

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?q=&providers.npi=1234567893
	->
	HTTP/1.1 200 OK
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	{
		"totalCount": 5,
		"count": 5,
		"offset": 0,
		"limit": 50,
		"links": {
			"self": {
				"href": "https://api.availity.com/demo/v1/claim-statuses?q=&providers.npi=1234567893"
			}
		},
		"claimStatuses": [
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/-6444806312330895858"
					}
				},
				"id": "-6444806312330895858",
				"customerId": "1194",
				"controlNumber": "36374",
				"userId": "aka71627884343",
				"status": "Complete",
				"statusCode": "4",
				"createdDate": "2015-06-05T17:50:30.000+0000",
				"updatedDate": "2015-06-05T17:50:30.000+0000",
				"expirationDate": "2015-06-06T17:50:30.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "12345678.90",
				"facilityTypeCode": "12",
				"facilityType": "Hospital Inpatient, Part B only",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTERID"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"middleName": "SUBSCRIBERMIDDLENAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"suffix": "III",
					"memberId": "BEAH276TESTGEN"
				},
				"patient": {
					"firstName": "PATIENTFIRSTNAME",
					"middleName": "PATIENTMIDDLENAME",
					"lastName": "PATIENTLASTNAME",
					"suffix": "III",
					"birthDate": "1999-09-09",
					"gender": "Male",
					"genderCode": "M",
					"accountNumber": "UNKNOWN",
					"subscriberRelationship": "Self",
					"subscriberRelationshipCode": "18"
				},
				"claimCount": "1"
			},
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/-1437397854912689422"
					}
				},
				"id": "-1437397854912689422",
				"customerId": "1194",
				"controlNumber": "36373",
				"userId": "aka71627884343",
				"status": "Complete (Invalid Response)",
				"statusCode": "3",
				"createdDate": "2015-06-05T17:47:23.000+0000",
				"updatedDate": "2015-06-05T17:47:23.000+0000",
				"expirationDate": "2015-06-06T17:47:23.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "12345678.90",
				"facilityTypeCode": "12",
				"facilityType": "Hospital Inpatient, Part B only",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTERID"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"memberId": "ABC123456789"
				},
				"patient": {
					"firstName": "PATIENTFIRSTNAME",
					"lastName": "PATIENTLASTNAME",
					"birthDate": "1999-09-09",
					"gender": "Male",
					"genderCode": "M",
					"accountNumber": "PAT1ENTACC0UNTNUMB3R",
					"subscriberRelationship": "Unknown",
					"subscriberRelationshipCode": "21"
				},
				"claimCount": "1"
			},
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/8093209937431557081"
					}
				},
				"id": "8093209937431557081",
				"customerId": "1194",
				"controlNumber": "36358",
				"userId": "aka71627884343",
				"status": "Complete",
				"statusCode": "4",
				"createdDate": "2015-06-05T15:52:42.000+0000",
				"updatedDate": "2015-06-05T15:52:42.000+0000",
				"expirationDate": "2015-06-06T15:52:42.000+0000",
				"fromDate": "2015-05-16T04:00:00.000+0000",
				"toDate": "2015-06-01T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "12345678.90",
				"facilityTypeCode": "12",
				"facilityType": "Hospital Inpatient, Part B only",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTERID"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"middleName": "SUBSCRIBERMIDDLENAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"suffix": "SR",
					"memberId": "CSI276MAXSUBPAT"
				},
				"patient": {
					"firstName": "PATIENTFIRSTNAME",
					"middleName": "PATIENTMIDDLENAME",
					"lastName": "PATIENTLASTNAME",
					"suffix": "SR",
					"birthDate": "1988-08-08",
					"gender": "Female",
					"genderCode": "F",
					"accountNumber": "277PATIENTACCTNUM-NOCLAIMNUM123",
					"subscriberRelationship": "Unknown",
					"subscriberRelationshipCode": "21"
				},
				"claimCount": "2"
			},
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/3537415793032824843"
					}
				},
				"id": "3537415793032824843",
				"customerId": "1194",
				"controlNumber": "36371",
				"userId": "aka71627884343",
				"status": "Complete",
				"statusCode": "4",
				"createdDate": "2015-06-04T21:00:50.000+0000",
				"updatedDate": "2015-06-04T21:00:50.000+0000",
				"expirationDate": "2015-06-05T21:00:50.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "8879999.99",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTER1D"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"middleName": "SUBSCRIBERMIDDLENAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"suffix": "SR",
					"memberId": "CSI276MAXSUBPAT"
				},
				"patient": {
					"firstName": "PATIENTFIRSTNAME",
					"middleName": "PATIENTMIDDLENAME",
					"lastName": "PATIENT LASTNAME",
					"suffix": "SR",
					"birthDate": "1912-11-10",
					"gender": "Female",
					"genderCode": "F",
					"accountNumber": "277PATIENTACCTNUM-NOCLAIMNUM123",
					"subscriberRelationship": "Unknown",
					"subscriberRelationshipCode": "21"
				},
				"claimCount": "2"
			},
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/-9022098185210411357"
					}
				},
				"id": "-9022098185210411357",
				"customerId": "1194",
				"controlNumber": "36370",
				"userId": "aka71627884343",
				"status": "Complete",
				"statusCode": "4",
				"createdDate": "2015-06-04T20:47:41.000+0000",
				"updatedDate": "2015-06-04T20:47:41.000+0000",
				"expirationDate": "2015-06-05T20:47:41.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "8879999.99",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTER1D"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"memberId": "CSI276SUBPATTEST"
				},
				"patient": {
					"lastName": "PATIENTLASTNAME",
					"birthDate": "1911-09-11",
					"gender": "Male",
					"genderCode": "M",
					"accountNumber": "277PATIENTACCTNUM-NOCLAIMNUM123",
					"subscriberRelationship": "Unknown",
					"subscriberRelationshipCode": "21"
				},
				"claimCount": "2"
			}
		]
	}

Inquiry Mode

The third way to interact with the endpoint is called inquiry mode. It allows you to search the health plan's system for claim status information. It functions in an asynchronous manner. We will return a 202 status code and location header while we process the request. Once we hear back from the health plan, we will insert any new claim statuses into our database. This mode enforces request validation that can vary by health plan. You can find detailed information about the rules by querying our configurations endpoint with a type of claim-statuses-inquiry. In general, you can send as many parameters as you want; Availity will ignore ones that are not supported by the specified health plan.

If your request is invalid, we will respond with a status code of 400 and a list of errors for you to correct.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?payer.id=BCBSF&submitter.lastName=SUBMITTERLASTNAME&submitter.firstName=SUBMITTERFIRSTNAME&submitter.id=SUBMITTERID&providers.lastName=PROVIDERLASTNAME&providers.firstName=PROVIDERFIRSTNAME&providers.npi=7654321&subscriber.memberId=ABC123456789&subscriber.lastName=SUBSCRIBERLASTNAME&subscriber.firstName=SUBSCRIBERFIRSTNAME&patient.lastName=PATIENTLASTNAME&patient.firstName=PATIENTFIRSTNAME&patient.birthDate=1999-09-09&patient.genderCode=M&patient.accountNumber=PAT1ENTACC0UNTNUMB3R&patient.subscriberRelationshipCode=01&fromDate=2015-05-15&toDate=2015-05-19&claimNumber=CL4IM2TATUSNUM8ER&claimAmount=12345678.90&facilityTypeCode=12&frequencyTypeCode=1
	->
	HTTP/1.1 400 Bad Request
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	{
		"userMessage": "The request was invalid. See the 'errors' property for details.",
		"developerMessage": "The request was invalid. See the 'errors' property for details.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode": 0,
		"statusCode": 400,
		"errors": [
			{
				"field": "providers.npi",
				"errorMessage": "Enter a valid Requesting Provider National Provider Identifier (NPI) containing 10 numeric digits and beginning with a 1, 2, 3, or 4.",
				"index": 0
			}
		}
	}

If your request is valid, we will respond with a status code of 202 and a location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?payer.id=BCBSF&submitter.lastName=SUBMITTERLASTNAME&submitter.firstName=SUBMITTERFIRSTNAME&submitter.id=SUBMITTERID&providers.lastName=PROVIDERLASTNAME&providers.firstName=PROVIDERFIRSTNAME&providers.npi=1234567893&subscriber.memberId=ABC123456789&subscriber.lastName=SUBSCRIBERLASTNAME&subscriber.firstName=SUBSCRIBERFIRSTNAME&patient.lastName=PATIENTLASTNAME&patient.firstName=PATIENTFIRSTNAME&patient.birthDate=1999-09-09&patient.genderCode=M&patient.accountNumber=PAT1ENTACC0UNTNUMB3R&patient.subscriberRelationshipCode=01&fromDate=2015-05-15&toDate=2015-05-19&claimNumber=CL4IM2TATUSNUM8ER&claimAmount=12345678.90&facilityTypeCode=12&frequencyTypeCode=1
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	Location: https://api.availity.com/demo/v1/claim-statuses?
	X-Status-Message: We are processing your request.
	{
		"totalCount": 0,
		"count": 0,
		"offset": 0,
		"limit": 50,
		"links": {
			"self": {
				"href": "https://api.availity.com/demo/v1/claim-statuses?
			}
		},
		"claimStatuses": []
	}

If the health plan responds with validation messages indicating that they were unable to fulfill your request, we will respond with a status code of 400 and a list of errors from the health plan.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?payer.id=BCBSF&submitter.lastName=SUBMITTERLASTNAME&submitter.firstName=SUBMITTERFIRSTNAME&submitter.id=SUBMITTERID&providers.lastName=PROVIDERLASTNAME&providers.firstName=PROVIDERFIRSTNAME&providers.npi=1234567893&subscriber.memberId=ABC123456789&subscriber.lastName=SUBSCRIBERLASTNAME&subscriber.firstName=SUBSCRIBERFIRSTNAME&patient.lastName=PATIENTLASTNAME&patient.firstName=PATIENTFIRSTNAME&patient.birthDate=1999-09-09&patient.genderCode=M&patient.accountNumber=PAT1ENTACC0UNTNUMB3R&patient.subscriberRelationshipCode=01&fromDate=2012-12-01&toDate=2012-12-01&claimNumber=CL4IM2TATUSNUM8ER&claimAmount=12345678.90&facilityTypeCode=12&frequencyTypeCode=1
	->
	HTTP/1.1 400 Bad Request
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	{
		"userMessage": "The request was invalid. See the 'errors' property for details.",
		"developerMessage": "The request was invalid. See the 'errors' property for details.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode": 0,
		"statusCode": 400,
		"errors": [
			{
				"code": "E1:90",
				"errorMessage": "Response not possible  System Status - Entity not eligible for medical benefits for submitted dates of service"
			},
			{
				"code": "A4:35",
				"errorMessage": "Acknowledgement/Not Found  The Claim/Encounter cannot be found in the adjudication system - Claim/Encounter not found"
			},
			{
				"code": "A4:187",
				"errorMessage": "Acknowledgement/Not Found  The Claim/Encounter cannot be found in the adjudication system - Date(s) of service"
			}]
	}

If we are unable to communicate with the health plan (due to maintenance), we will respond with a status code of 504 and a message indicating that the health plan is down for maintenance.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?payer.id=BCBSF&submitter.lastName=SUBMITTERLASTNAME&submitter.firstName=SUBMITTERFIRSTNAME&submitter.id=SUBMITTERID&providers.lastName=PROVIDERLASTNAME&providers.firstName=PROVIDERFIRSTNAME&providers.npi=1234567893&subscriber.memberId=ABC123456789&subscriber.lastName=SUBSCRIBERLASTNAME&subscriber.firstName=SUBSCRIBERFIRSTNAME&patient.lastName=PATIENTLASTNAME&patient.firstName=PATIENTFIRSTNAME&patient.birthDate=1999-09-09&patient.genderCode=M&patient.accountNumber=PAT1ENTACC0UNTNUMB3R&patient.subscriberRelationshipCode=01&fromDate=2015-05-15&toDate=2015-05-19&claimNumber=CL4IM2TATUSNUM8ER&claimAmount=12345678.90&facilityTypeCode=12&frequencyTypeCode=1
	->
	HTTP/1.1 504 Gateway Timeout
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	{
		"userMessage":"The health plan is down for maintenance.",
		"developerMessage":"We were unable to complete a transaction with the payer.",
		"documentation": "https://developer.availity.com/documentation",
		"reasonCode":7,
		"statusCode":504
	}

Once the health plan has successfully fulfilled your request, we will respond with a status code of 200 and summaries of each claim status we found.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses?payer.id=BCBSF&submitter.lastName=SUBMITTERLASTNAME&submitter.firstName=SUBMITTERFIRSTNAME&submitter.id=SUBMITTERID&providers.lastName=PROVIDERLASTNAME&providers.firstName=PROVIDERFIRSTNAME&providers.npi=1234567893&subscriber.memberId=ABC123456789&subscriber.lastName=SUBSCRIBERLASTNAME&subscriber.firstName=SUBSCRIBERFIRSTNAME&patient.lastName=PATIENTLASTNAME&patient.firstName=PATIENTFIRSTNAME&patient.birthDate=1999-09-09&patient.genderCode=M&patient.accountNumber=PAT1ENTACC0UNTNUMB3R&patient.subscriberRelationshipCode=01&fromDate=2015-05-15&toDate=2015-05-19&claimNumber=CL4IM2TATUSNUM8ER&claimAmount=12345678.90&facilityTypeCode=12&frequencyTypeCode=1
	->
	HTTP/1.1 200 OK
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Connection: close
	Content-Type: application/json
	Date: Tue, 09 Jun 2015 19:54:52 GMT
	X-Global-Transaction-ID: 113993145
	X-Session-ID: 84f311c9-7aca-45fe-b256-d6049c499d66
	x-api-id: 84f311c9-7aca-45fe-b256-d6049c499d66
	X-Api-Mock-Response: true
	{
		"totalCount": 1,
		"count": 1,
		"offset": 0,
		"limit": 1,
		"links": {
			"self": {
				"href": "https://api.availity.com/demo/v1/claim-statuses?id=-1437397854912689422
			}
		},
		"claimStatuses": [
			{
				"links": {
					"self": {
						"href": "https://api.availity.com/demo/v1/claim-statuses/-1437397854912689422"
					}
				},
				"id": "-1437397854912689422",
				"customerId": "1194",
				"userId": "aka71627884343",
				"status": "In Progress",
				"statusCode": "0",
				"createdDate": "2015-06-05T17:47:23.000+0000",
				"updatedDate": "2015-06-05T17:47:23.000+0000",
				"expirationDate": "2015-06-06T17:47:23.000+0000",
				"fromDate": "2015-05-15T04:00:00.000+0000",
				"toDate": "2015-05-19T04:00:00.000+0000",
				"claimNumber": "CL4IM2TATUSNUM8ER",
				"claimAmount": "12345678.90",
				"facilityTypeCode": "12",
				"facilityType": "Hospital Inpatient, Part B only",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"payer": {
					"id": "BCBSF"
				},
				"submitter": {
					"lastName": "SUBMITTERLASTNAME",
					"firstName": "SUBMITTERFIRSTNAME",
					"id": "SUBMITTERID"
				},
				"providers": [
					{
						"lastName": "PROVIDERLASTNAME",
						"firstName": "PROVIDERFIRSTNAME",
						"npi": "1234567893"
					}
				],
				"subscriber": {
					"firstName": "SUBSCRIBERFIRSTNAME",
					"lastName": "SUBSCRIBERLASTNAME",
					"memberId": "ABC123456789"
				},
				"patient": {
					"firstName": "PATIENTFIRSTNAME",
					"lastName": "PATIENTLASTNAME",
					"birthDate": "1999-09-09",
					"gender": "Male",
					"genderCode": "M",
					"accountNumber": "PAT1ENTACC0UNTNUMB3R",
					"subscriberRelationship": "Spouse",
					"subscriberRelationshipCode": "01"
				}
			}
		]
	}

GET /V1/CLAIM-STATUSES/:ID

You can retrieve a claim status using this endpoint.

Example

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/claim-statuses/5334032768852043884
	->
	HTTP/1.1 200 OK
	x-api-id: 98b6e65a-4d97-47f7-b9dc-2addb6544895
	X-Session-ID: 98b6e65a-4d97-47f7-b9dc-2addb6544895
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Tue, 9 Jun 2015 09:30:37 GMT
	X-Global-Transaction-ID: 37112879
	Connection: close
	{
		"links": {
			"self": {
				"href": "https://api.availity.com/demo/v1/claim-statuses/5334032768852043884"
			}
		},
		"id": "5334032768852043884",
		"customerId": "1194",
		"controlNumber": "36392",
		"userId": "userid",
		"status": "Complete",
		"statusCode": "4",
		"createdDate": "2015-06-08T15:41:42.000+0000",
		"updatedDate": "2015-06-08T15:41:42.000+0000",
		"expirationDate": "2015-06-12T17:20:25.000+0000",
		"payer": {
			"id": "BCBSF",
			"name": "BCBSF"
		},
		"submitter": {
			"lastName": "DOCTORS OFFICE",
			"id": "G8486"
		},
		"providers": [
			{
				"lastName": "DOCTORS OFFICE"
				"npi": "1003847047"
			}
		],
		"subscriber": {
			"firstName": "JAMES",
			"middleName": "E",
			"lastName": "JONES",
			"memberId": "ABCD1234567"
		},
		"patient": {
			"firstName": "JAMES",
			"middleName": "E",
			"lastName": "JONES",
			"birthDate": "1991-11-28",
			"gender": "Male",
			"genderCode": "M",
			"accountNumber": "UNKNOWN",
			"subscriberRelationship": "Self",
			"subscriberRelationshipCode": "18"
		},
		"claimStatuses": [
			{
				"traceId": "534180414",
				"claimControlNumber": "Q100000471322718",
				"facilityTypeCode": "13",
				"facilityType": "Hospital Outpatient",
				"frequencyTypeCode": "1",
				"frequencyType": "Admit thru Discharge Claim",
				"patientControlNumber": "UNKNOWN",
				"fromDate": "2015-05-15",
				"toDate": "2015-05-15",
				"statusDetails": [
					{
						"category": "Finalized  The Claim/Encounter has completed the adjudication cycle and no more action will be taken",
						"categoryCode": "F0",
						"status": "Awaiting next periodic adjudication cycle",
						"statusCode": "38",
						"effectiveDate": "2015-06-01",
						"claimAmount": "1568.34",
						"claimAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"finalizedDate": "2015-05-27",
						"remittanceDate": "2015-06-01",
						"checkNumber": "203881588"
					}
				],
				"serviceLines": [
					{
						"procedureQualifier": "National Uniform Billing Committee (NUBC) UB92 Codes",
						"procedureQualifierCode": "NU",
						"chargeAmount": "195.87",
						"chargeAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"quantity": "1",
						"controlNumber": "1",
						"fromDate": "2015-05-15",
						"toDate": "2015-05-15",
						"statusDetails": [
							{
								"category": "Finalized/Payment  The Claim/Line has been paid",
								"categoryCode": "F1",
								"status": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
								"statusCode": "107",
								"effectiveDate": "2015-06-01"
							}
						]
					},
					{
						"procedureQualifier": "National Uniform Billing Committee (NUBC) UB92 Codes",
						"procedureQualifierCode": "NU",
						"chargeAmount": "195.79",
						"chargeAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"quantity": "1",
						"controlNumber": "2",
						"fromDate": "2015-05-15",
						"toDate": "2015-05-15",
						"statusDetails": [
							{
								"category": "Finalized/Payment  The Claim/Line has been paid",
								"categoryCode": "F1",
								"status": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
								"statusCode": "107",
								"effectiveDate": "2015-06-01"
							}
						]
					},
					{
						"procedureQualifier": "National Uniform Billing Committee (NUBC) UB92 Codes",
						"procedureQualifierCode": "NU",
						"chargeAmount": "7.52",
						"chargeAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"quantity": "1",
						"controlNumber": "3",
						"fromDate": "2015-05-15",
						"toDate": "2015-05-15",
						"statusDetails": [
							{
								"category": "Finalized/Payment  The Claim/Line has been paid",
								"categoryCode": "F1",
								"status": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
								"statusCode": "107",
								"effectiveDate": "2015-06-01"
							}
						]
					},
					{
						"procedureQualifier": "National Uniform Billing Committee (NUBC) UB92 Codes",
						"procedureQualifierCode": "NU",
						"chargeAmount": "412.54",
						"chargeAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"quantity": "1",
						"controlNumber": "4",
						"fromDate": "2015-05-15",
						"toDate": "2015-05-15",
						"statusDetails": [
							{
								"category": "Finalized/Payment  The Claim/Line has been paid",
								"categoryCode": "F1",
								"status": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
								"statusCode": "107",
								"effectiveDate": "2015-06-01"
							}
						]
					},
					{
						"procedureQualifier": "National Uniform Billing Committee (NUBC) UB92 Codes",
						"procedureQualifierCode": "NU",
						"chargeAmount": "385.41",
						"chargeAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"quantity": "1",
						"controlNumber": "5",
						"fromDate": "2015-05-15",
						"toDate": "2015-05-15",
						"statusDetails": [
							{
								"category": "Finalized/Payment  The Claim/Line has been paid",
								"categoryCode": "F1",
								"status": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
								"statusCode": "107",
								"effectiveDate": "2015-06-01"
							}
						]
					},
					{
						"procedureQualifier": "National Uniform Billing Committee (NUBC) UB92 Codes",
						"procedureQualifierCode": "NU",
						"chargeAmount": "371.21",
						"chargeAmountUnits": "USD",
						"paymentAmount": "0",
						"paymentAmountUnits": "USD",
						"quantity": "1",
						"controlNumber": "6",
						"fromDate": "2015-05-15",
						"toDate": "2015-05-15",
						"statusDetails": [
							{
								"category": "Finalized/Payment  The Claim/Line has been paid",
								"categoryCode": "F1",
								"status": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
								"statusCode": "107",
								"effectiveDate": "2015-06-01"
							}
						]
					}
				]
			}
		],
		"claimCount": "1"
	}

Responses

HTTP Status Code	Description
200	We have returned an up to date copy of the resource.
202	We have not yet received a response from the health plan, but are still trying. You should try again later.
400	The health plan indicated that something is wrong with the request. The resource should have a list of validationMessages. Correct and resubmit the request.
404	We did not find a ClaimStatus with the id that you specified.
504	We did not receive a respsone from the health plan within the time allotted. You should try your request again later.

DELETE /V1/CLAIM-STATUSES/:ID

You can delete a claim status using this endpoint.

Example

	$ curl -H "x-api-key: $API_KEY" -X DELETE -i https://api.availity.com/demo/v1/claim-statuses/-3067319688589945459
	->
	HTTP/1.1 204 No Content
	x-api-id: 98b6e65a-4d97-47f7-b9dc-2addb6544895
	X-Session-ID: 98b6e65a-4d97-47f7-b9dc-2addb6544895
	X-Api-Mock-Response: true
	Cache-Control: private, no-store, max-age=0, must-revalidate
	Content-Type: application/json
	Date: Tue, 9 Jun 2015 09:30:37 GMT
	X-Global-Transaction-ID: 37112879
	Connection: close

Responses

HTTP Status Code	Description
204	We have deleted the resource from our system.
404	We did not find a ClaimStatus with the id that you specified.

Care Cost Estimator - Professional

A Care Cost Estimator (CCE), also known as Predetermination, is a claim request for payment that a health care provider submits to a health plan before they've provided a service or items to a member. Your application can use this endpoint to submit an professional claim predetermination for an professional claim, additionally you can use the endpoint to find and manage previous claim predetermination requests.

Working with the DEMO endpoints

Availity allows you to specify the type of response you want when interacting with our Professional Care Cost Estimator demonstration service by sending a header (X-Api-Mock-Scenario-ID) with the appropriate response scenario id. The supported response scenarios are listed below.

For POST methods send an empty JSON body such as: "{}"

Response Scenario ID	Method	HTTP Status	Description
CCEP-Success	GET - use id 123	200	Availity has successfully retrieved the member's claim predetermination information from the health plan.
CCEP-Accepted	POST	202	Availity is in the process of retrieving the member's claim predetermination information from the health plan.
CCEP-RequestErrors1	POST	400	Your request failed Availity's input validation rules.
CCEP-RequestErrors2	POST	400	Your request failed Availity's input validation rules.
CCEP-RequestParseError	POST	500	We were unable to parse your request.
CCEP-MultiServiceLines	GET - use id 54321	200	Availity has successfully retrieved the member's claim predetermination information that contains multiple service lines from the health plan.

You can confirm you've received a mock response by inspecting the response headers. You should see the following header:

	X-Api-Mock-Response: true

Overview

A predetermination of benefits is a review by a health plans automated claim processing system or a their medical staff to decide if they agree that the treatment is right for the patient's health needs. A predetermination is done before a patient receives healthcare. This allows the patient to know early if it is covered by their health plan.

Each health plan has different required information they need to process a CCE. Because of this, you'll want to ensure you utilize the Configurations service to determine the required fields for a specific health plan before submitting it. See the Configurations service for details on it's use.

Configuration Service Subtype

The type name for the professional-claims service is: professional-claims Use the subtypeId name of: PRE_DETERMINATION

Example usage:

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/configurations?type=professional-claims&payerId=BCBSF&subtypeId=PRE_DETERMINATION

Submitting a Predetermination Claim

The PRE_DETERMINATION request type submits a claim request to a health plan to determine a patient's out of pocket estimate based on their plans coverage. Note that this does not produce an adjudicated claim.

The Resource

Field	Type	Description
id	String	A unique identifier that Availity has assigned to this ProfessionalClaim.
createdDate	TimeStamp	The date and time when this item was created in Availity's system.
updatedDate	TimeStamp	The date and time when this item was last updated.
expirationDate	TimeStamp	The date and time when this item will be removed from Availity's system.
customerId	String	The id of the Availity customer that owns this ProfessionalClaim. Availity may ask for this during support calls.
requestTypeCode	String	The type of request to perform for professional claims. Use PRE_DETERMINATION for Predetermination.
submitter	Object	An object representing the submitter of a claim.
submitter.lastName	String	The last or business name of the submitter.
submitter.firstName	String	The first name of the submitter.
submitter.middleName	String	The middle name of the submitter.
submitter.suffix	String	The suffix of the submitter.
submitter.id	String	The identifier of the submitter.
submitter.contactName	String	The contact name of the submitter.
submitter.phone	String	The phone number of the submitter.
submitter.extension	String	The phone extension of the submitter.
submitter.fax	String	The fax number of the submitter.
submitter.email	String	The email of the submitter.
payer	Object	An object representing the health plan of the patient.
payer.id	String	The Availity id of the health plan.
payer.name	String	The name of the health plan.
payer.claimFilingIndicatorCode	String	The claim filing indicator code for the type of insurance.
billingProvider	Object	An object representing the billing provider of the claim.
billingProvider.specialtyCode	String	The claim filing indicator code for the type of insurance.
billingProvider.lastName	String	The last name of individual (Person) or business name (Non-Person Entity) of the billing provider. – REQUIRED
billingProvider.firstName	String	The first name of the billing provider. Situational: REQUIRED if submitting Individual (Person) billingProvider.ein or billingProvider.ssn
billingProvider.middleName	String	The middle name of the billing provider.
billingProvider.suffix	String	The suffix of the billing provider.
billingProvider.npi	String	The national provider id of the billing provider.
billingProvider.addressLine1	String	The first line of the address of the billing provider.
billingProvider.addressLine2	String	The second line of the address of the billing provider.
billingProvider.city	String	The city of the billing provider.
billingProvider.stateCode	String	The code of the state of the billing provider.
billingProvider.zipCode	String	The ZIP code of the billing provider.
billingProvider.ein	String	The employer identification number of the billing provider.
billingProvider.ssn	String	The social security number of the billing provider.
billingProvider.stateLicenseNumber	String	The state license number of the billing provider.
billingProvider.payerAssignedProviderId	String	The payer assigned provider id of the billing provider.
billingProvider.contactName	String	The contact name of the billing provider.
billingProvider.phone	String	The phone number of the billing provider.
billingProvider.extension	String	The phone extension of the billing provider.
billingProvider.fax	String	The fax number of the billing provider.
billingProvider.email	String	The email of the billing provider.
billingProvider.payTo.addressLine1	String	The first line of the address for the pay to of the billing provider.
billingProvider.payTo.addressLine2	String	The second line of the address for the pay to of the billing provider.
billingProvider.payTo.city	String	The city of the pay to of the billing provider.
billingProvider.payTo.stateCode	String	The code of the state for the pay to of the billing provider.
billingProvider.payTo.zipCode	String	The ZIP code for the pay to of the billing provider.
subscriber	Object	An object representing the subscriber of the claim.
subscriber.lastName	String	The last or business name of the subscriber.
subscriber.firstName	String	The first name of the subscriber.
subscriber.middleName	String	The middle name of the subscriber.
subscriber.suffix	String	The suffix of the subscriber.
subscriber.memberId	String	The member id of the subscriber.
subscriber.groupNumber	String	The group number of the subscriber.
subscriber.groupName	String	The group name of the subscriber.
subscriber.addressLine1	String	The first line of the address of the subscriber.
subscriber.addressLine2	String	The second line of the address of the subscriber.
subscriber.city	String	The city of the subscriber.
subscriber.stateCode	String	The code of the state of the subscriber.
subscriber.zipCode	String	The ZIP code of the subscriber.
subscriber.totalDeductible	String	The total individual deductible dollar amount for this health care plan.
subscriber.accumulatedDeductible	String	The accumulated individual deductible dollar amount for this health care plan.
subscriber.remainingDeductible	String	The remaining individual deductible dollar amount for this health care plan.
subscriber.onHold	Boolean	Indicates where the subscriber is on hold.
subscriber.holdReasons	Object Array	An array of hold reasons for the claim.
subscriber.holdReasons.code	String	A code indicating the hold reason.
subscriber.holdReasons.description	String	A description for why the hold is in place.
patient	Object	An object representing the patient of the claim.
patient.lastName	String	The last or business name of the patient.
patient.firstName	String	The first name of the patient.
patient.middleName	String	The middle name of the patient.
patient.suffix	String	The suffix of the patient.
patient.addressLine1	String	The first line of the address of the patient.
patient.addressLine2	String	The second line of the address of the patient.
patient.city	String	The city of the patient.
patient.stateCode	String	The code of the state of the patient.
patient.zipCode	String	The ZIP code of the patient.
patient.birthDate	Date	The birth date of the patient.
patient.gender	String	A description of the gender of the patient.
patient.genderCode	String	A code representing the gender of the patient.
patient.subscriberRelationship	String	A description of the patient's relationship to the subscriber.
patient.subscriberRelationshipCode	String	A code representing the patient's relationship to the subscriber.
claimInformation	Object	An object representing the claim information of the claim.
claimInformation.bundled	Boolean	Indicating whether the payer believes that the actual services performed and reported must be paid under only one procedure code.
claimInformation.controlNumber	String	A unique reference identifier provided by the submitter.
claimInformation.placeOfServiceCode	String	A code representing the place of service.
claimInformation.frequencyTypeCode	String	A code specifying the frequency of the claim.
claimInformation.providerSignatureOnFile	Boolean	Indicates whether a provider's signature is on file with the healthcare plan.
claimInformation.providerAcceptAssignmentCode	String	A code indicating whether the provider accepts assignment.
claimInformation.benefitsAssignmentCertification	String	A code indicating assignment of benefits for a claim.
claimInformation.informationReleaseCode	String	A code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations.
claimInformation.displayMessage	String	The display message a payer may return.
claimInformation.messages	Object Array	An array of messages.
claimInformation.messages.code	String	The message code.
claimInformation.messages.description	String	The message description.
claimInformation.messages.procedure	String	The procedure for the message.
claimInformation.diagnoses	Object Array	An array of diagnosis codes for the claim.
claimInformation.diagnoses.qualifier	String	The description of the qualifier indicating what type of diagnosis code is used.
claimInformation.diagnoses.qualifierCode	String	A code representing the qualifier indicating what type of diagnosis code is used.
claimInformation.diagnoses.code	String	A code representing the diagnosis.
claimInformation.serviceLines	Object Array	An array of service lines for the claim.
claimInformation.serviceLines.fromDate	String	The start date of the service.
claimInformation.serviceLines.toDate	String	The end date of the service.
claimInformation.serviceLines.controlNumber	String	A unique reference identifier provided by the submitter.
claimInformation.serviceLines.placeOfServiceCode	String	A code representing the place of service. This overrides the placeOfServiceCode at the Claim Information level.
claimInformation.serviceLines.procedureCode	String	A code representing the procedure performed.
claimInformation.serviceLines.modifierCode1	String	A description of the first modifier applied to this procedure.
claimInformation.serviceLines.modifierCode2	String	A description of the second modifier applied to this procedure.
claimInformation.serviceLines.modifierCode3	String	A description of the third modifier applied to this procedure.
claimInformation.serviceLines.modifierCode4	String	A description of the forth modifier applied to this procedure.
claimInformation.serviceLines.diagnosisCodePointer1	String	A pointer to the first diagnosis code in this service.
claimInformation.serviceLines.diagnosisCodePointer2	String	A pointer to the second diagnosis code in this service.
claimInformation.serviceLines.diagnosisCodePointer3	String	A pointer to the third diagnosis code in this service.
claimInformation.serviceLines.diagnosisCodePointer4	String	A pointer to the forth diagnosis code in this service.
claimInformation.serviceLines.amount	String	This total charge amount for this service line. The amount is inclusive of the provider’s base charge and any applicable tax and/or postage claimed amounts.
claimInformation.serviceLines.quantity	String	The units of service.
claimInformation.serviceLines.quantityTypeCode	String	A code representing the quantity units.
claimInformation.serviceLines.estimatedPatientResponsibility	String	The estimated amount of the patient's responsibility.
claimInformation.serviceLines.bundlingDescription	String	The service bundling description.
claimInformation.serviceLines.denyReason	String	The reason why the procedure is denied.
claimInformation.serviceLines.holdReasons	Object Array	An array of hold reasons for the procedure.
claimInformation.serviceLines.holdReasons.code	String	The hold reason code.
claimInformation.serviceLines.holdReasons.description	String	The hold reason description.
claimInformation.serviceLines.messages	Object Array	An array of messages for the procedure.
claimInformation.serviceLines.messages.code	String	The message code.
claimInformation.serviceLines.messages.description	String	The message description.
claimInformation.serviceLines.messages.procedure	String	The procedure for the message.
claimInformation.serviceLines.displayMessage	String	The display message a payer may return.
claimInformation.serviceLines.allowed	Object	An object representing the allowed portion of the procedure performed.
claimInformation.serviceLines.allowed.amount	String	The amount allowed for the procedure performed.
claimInformation.serviceLines.allowed.code	String	The code for the procedure performed.
claimInformation.serviceLines.allowed.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.allowed.description	String	The description of the allowed amount the procedure performed.
claimInformation.serviceLines.allowed.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.allowed.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.notCovered	Object	An object representing the not covered portion of the procedure performed.
claimInformation.serviceLines.notCovered.amount	String	The amount not covered for the procedure performed.
claimInformation.serviceLines.notCovered.code	String	The code for the procedure performed.
claimInformation.serviceLines.notCovered.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.notCovered.description	String	The description of the not covered amount the procedure performed.
claimInformation.serviceLines.notCovered.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.notCovered.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.coPay	Object	An object representing the copay portion of the procedure performed.
claimInformation.serviceLines.coPay.amount	String	The amount of copay for the procedure performed.
claimInformation.serviceLines.coPay.code	String	The code for the procedure performed.
claimInformation.serviceLines.coPay.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.coPay.description	String	The description of the copay amount the procedure performed.
claimInformation.serviceLines.coPay.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.coPay.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.coInsurance	Object	An object representing the co-insurance portion of the procedure performed.
claimInformation.serviceLines.coInsurance.amount	String	The amount of co-insurance for the procedure performed.
claimInformation.serviceLines.coInsurance.code	String	The code for the procedure performed.
claimInformation.serviceLines.coInsurance.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.coInsurance.description	String	The description of the co-insurance amount the procedure performed.
claimInformation.serviceLines.coInsurance.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.coInsurance.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.deductible	Object	An object representing the deductible portion of the procedure performed.
claimInformation.serviceLines.deductible.amount	String	The amount of deductible for the procedure performed.
claimInformation.serviceLines.deductible.code	String	The code for the procedure performed.
claimInformation.serviceLines.deductible.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.deductible.description	String	The description of the deductible amount the procedure performed.
claimInformation.serviceLines.deductible.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.deductible.patientLiable	Boolean	Indicates whether the patient is liable.

POST /V1/PROFESSIONAL-CLAIMS

This endpoint creates a CCE asynchronously. To submit a CCE, make a valid request and a response will be returned with a location header containing a URL you can query for your result.

RESPONSES

HTTP Status Code	Description
202	The CCE was accepted for processing. Poll the URL in the Location header. The X-Status-Message header will contain additional detail.
400	The CCE request failed validation. It either failed our validation rules or was rejected by the health plan. The errors property will contain detailed information. Errors that specify a field are Availity validation rule failures. Errors that specify a code are from the health plan. Correct the errors and resubmit the request.
500	We were unable to parse your request. Correct the errors and resubmit the request.

VALIDATION RULES

The validation rules for the ProfessionalClaim resource can vary by health plan, the type of claim being requested, and the type of service to be performed. Availity organizes these rules and makes them available through the Configuration service. The Configuration resource documents the fields you need to send to create a ProfessionalClaim and explains what values are valid for those fields. See the Configurations service for details.

EXAMPLES

If your request is invalid, we will respond with a status code of 400 and a list of errors for you to correct.

	$ curl -i -H "x-api-key: $API_KEY" -H "Content-Type: application/json" -X POST -d '{
	  "requestTypeCode": "PRE_DETERMINATION",
	  "billingProvider": {
		"npi": "123456789"
	  },
	  "patient": {
		"relationshipCode": "01",
		"lastName": "Smith",
		"firstName": "Bob",
		"stateCode": "FL",
		"birthDate": "1980-02-12",
		"genderCode": "M"
	  },
	  "payer": {
		"id": "BCBSF"
	  },
	  "submitter": {
		"id": "123456789",
		"lastName": "SUBMITTER"
	  },
	  "subscriber": {
		"memberId": "JDH001",
		"groupName": "ASDF 1-2",
		"groupNumber": "12312412"
	  },
	  "claimInformation": {
		"placeOfServiceCode": "11",
		"diagnoses": [
		  {
			"qualifierCode": "ABK",
			"code": "J3089"
		  }
		],
		"serviceLines": [
		  {
			"procedureCode": "92523",
			"quantity": "100",
			"amount": "250",
			"fromDate": "2016-05-10"
		  }
		]
	  }
	}' https://api.availity.com/demo/v1/professional-claims
	
	HTTP/1.1 400 Bad Request
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json
	Date: Fri, 03 Jun 2016 18:19:16 GMT
	x-api-id: 7407a7ee-1940-4c8b-b9ec-57e9b0059214
	X-Session-ID: 7407a7ee-1940-4c8b-b9ec-57e9b0059214
	Connection: close
	
	{
	  "userMessage" : "Your request was invalid.",
	  "developerMessage" : "The request was invalid. See the 'errors' property for details.",
	  "reasonCode" : 0,
	  "statusCode" : 400,
	  "errors" : [ {
		"field" : "billingProvider.ein",
		"errorMessage" : "Enter a valid Billing Provider EIN.",
		"index" : 0,
		"nestedEntityErrors" : [ ]
	  }, {
		"field" : "billingProvider.npi",
		"errorMessage" : "Enter a valid Billing Provider National Provider Identifier (NPI) containing 10 numeric digits and beginning with a 1, 2, 3, or 4.",
		"index" : 0,
		"nestedEntityErrors" : [ ]
	  }, {
		"field" : "billingProvider.payerAssignedProviderId",
		"errorMessage" : "Enter a valid Billing Provider Payer Assigned Provider ID",
		"index" : 0,
		"nestedEntityErrors" : [ ]
	  } ]
	}

If your request is valid, we will respond with a status code of 202 and a location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -i -H "x-api-key: $API_KEY" -H "Content-Type: application/json" -X POST -d '{
	  "requestTypeCode": "PRE_DETERMINATION",
	  "billingProvider": {
		"npi": "1234567893",
		"ein": "111222333",
		"payerAssignedProviderId": "XYZ321"
	  },
	  "patient": {
		"relationshipCode": "01",
		"lastName": "Smith",
		"firstName": "Bob",
		"stateCode": "FL",
		"birthDate": "1980-02-12",
		"genderCode": "M"
	  },
	  "payer": {
		"id": "BCBSF"
	  },
	  "submitter": {
		"id": "123456789",
		"lastName": "SUBMITTER"
	  },
	  "subscriber": {
		"memberId": "JDH001",
		"groupName": "ASDF 1-2",
		"groupNumber": "12312412"
	  },
	  "claimInformation": {
		"placeOfServiceCode": "11",
		"diagnoses": [
		  {
			"qualifierCode": "ABK",
			"code": "J3089"
		  }
		],
		"serviceLines": [
		  {
			"procedureCode": "92523",
			"quantity": "100",
			"amount": "250",
			"fromDate": "2016-05-10"
		  }
		]
	  }
	}' https://api.availity.com/demo/v1/professional-claims
	
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Fri, 03 Jun 2016 20:00:40 GMT
	Location: https://api.availity.com/demo/v1/professional-claims/1684335841477061460
	x-api-id: 78a4490e-8437-49c1-a5b5-0eab3ba1d996
	X-Session-ID: 78a4490e-8437-49c1-a5b5-0eab3ba1d996
	X-Status-Message: We are processing your request.
	Connection: close

GET /V1/PROFESSIONAL-CLAIMS/:ID

You can retrieve a CCE using this endpoint.

RESPONSES

HTTP Status Code	Description
200	We are done processing your request and the response body contains the result.
202	We are currently processing your request. We may be retrying it.
400	Your CCE request failed validation. You can correct the errors and resubmit.
404	We did not find a ProfessionalClaim with the id that you sent.
504	We were unable to process your request. The health plan did not respond after several retry attempts. Please try your request again later.

EXAMPLES

You can request the URI that was returned in the Location response header during from your POST request. If the resource is found but we have not received a response from the health plan, we will respond with a status code of 202 and a Location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/professional-claims/1684335841477061460
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Mon, 06 Jun 2016 18:11:34 GMT
	Location: https://api.availity.com/demo/v1/professional-claims/1684335841477061460
	x-api-id: 25a71361-7f75-4dc9-918b-021e163b0df8
	X-Session-ID: 25a71361-7f75-4dc9-918b-021e163b0df8
	X-Status-Message: The health plan did not respond. We are retrying the request.
	Connection: close

Once we have a response from the health plan, we will respond with a status code of 200 and a ProfessionalClaim resource.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/professional-claims/1684335841477061460
	->
	HTTP/1.1 200 OK
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Mon, 06 Jun 2016 18:35:19 GMT
	x-api-id: 22d78708-6094-4e95-a8fe-3bb762975fd3
	X-Availity-Transaction-ID: 1613032
	X-Session-ID: 22d78708-6094-4e95-a8fe-3bb762975fd3
	Connection: close
	Server: Jetty(8.1.17.v20150415)
	
	{
	  "id" : "1684335841477061460",
	  "createdDate" : "2016-06-06T18:34:46.000+0000",
	  "updatedDate" : "2016-06-06T18:34:52.000+0000",
	  "expirationDate" : "2016-06-07T18:34:46.000+0000",
	  "requestTypeCode" : "PRE_DETERMINATION",
	  "submitter" : {
		"lastName" : "Island Ear Nose and Throat",
		"id" : "263749002"
	  },
	  "payer" : {
		"id" : "BCBSF"
	  },
	  "billingProvider" : {
		"npi" : "1255569224",
		"payerAssignedProviderId" : "G4402"
	  },
	  "subscriber" : {
		"memberId" : "H23183209",
		"totalDeductible" : "6100.00",
		"accumulatedDeductible" : "0.00",
		"remainingDeductible" : "6100.00",
		"onHold" : false
	  },
	  "patient" : {
		"lastName" : "CARIDAD",
		"firstName" : "ANISLEIDY",
		"birthDate" : "1992-11-22",
		"gender" : "Female",
		"genderCode" : "F",
		"subscriberRelationship" : "Self",
		"subscriberRelationshipCode" : "18"
	  },
	  "claimInformation" : {
		"bundled" : false,
		"diagnoses" : [ {
		  "qualifier" : "International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis",
		  "qualifierCode" : "ABK",
		  "code" : "J3089"
		} ],
		"serviceLines" : [ {
		  "procedure" : "PROFESSIONAL SVCS FOR THE SUPERVISION OF PREP & PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPE",
		  "procedureCode" : "95165",
		  "amount" : "2500.00",
		  "estimatedPatientResponsibility" : "10.00",
		  "allowed" : {
			"amount" : "1807.50",
			"code" : "PPSCH",
			"codeType" : "AL",
			"description" : "Allowed amount based on fee schedule",
			"patientLiable" : false
		  },
		  "coPay" : {
			"amount" : "10.00",
			"code" : "BCPI",
			"codeType" : "CP",
			"patientLiable" : true
		  }
		} ]
	  }
	}

Care Cost Estimator - Institutional

A Care Cost Estimator (CCE), also known as Predetermination, is a claim request for payment that a health care provider submits to a health plan before they've provided a service or items to a member. Your application can use this endpoint to submit an institutional claim predetermination for an institutional claim, additionally you can use the endpoint to find and manage previous claim predetermination requests.

Working with the DEMO endpoints

Availity allows you to specify the type of response you want when interacting with our Institutional Care Cost Estimator demonstration service by sending a header (X-Api-Mock-Scenario-ID) with the appropriate response scenario id. The supported response scenarios are listed below.

For POST methods send an empty JSON body such as: "{}"

Response Scenario ID	Method	HTTP Status	Description
CCEI-Success	GET - use id 123	200	Availity has successfully retrieved the member's CCE predetermination information from the health plan.
CCEI-Accepted	POST	202	Availity is in the process of retrieving the member's CCE predetermination information from the health plan.
CCEI-RequestErrors1	POST	400	Your request failed Availity's input validation rules.
CCEI-RequestErrors2	POST	400	Your request failed Availity's input validation rules.
CCEI-RequestParseError	POST	500	We were unable to parse your request.

You can confirm you've received a mock response by inspecting the response headers. You should see the following header:

	X-Api-Mock-Response: true

Overview

A predetermination of benefits is a review by a health plans automated claim processing system or a their medical staff to decide if they agree that the treatment is right for the patient's health needs. A predetermination is done before a patient receives healthcare. This allows the patient to know early if it is covered by their health plan.

Each health plan has different required information they need to process a CCE. Because of this, you'll want to ensure you utilize the Configurations service to determine the required fields for a specific health plan before submitting it. See the Configurations service for details on it's use.

Configuration Service Subtype

The type name for the institutional-claims service is: institutional-claims Use the subtypeId name of: PRE_DETERMINATION

Example usage:

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/configurations?type=institutional-claims&payerId=BCBSF&subtypeId=PRE_DETERMINATION

Submitting a Predetermination Institutional Claim

The PRE_DETERMINATION request subtype submits a claim request to a health plan to determine a patient's out of pocket estimate based on their plans coverage. Note that this does not produce an adjudicated claim.

The Resource

Field	Type	Description
id	String	A unique identifier that Availity has assigned to this InstitutionalClaim.
createdDate	TimeStamp	The date and time when this item was created in Availity's system.
updatedDate	TimeStamp	The date and time when this item was last updated.
expirationDate	TimeStamp	The date and time when this item will be removed from Availity's system.
customerId	String	The id of the Availity customer that owns this InstitutionalClaim. Availity may ask for this during support calls.
requestTypeCode	String	The type of request to perform for institutional claims. Use PRE_DETERMINATION for Predetermination.
submitter	Object	An object representing the submitter of a claim.
submitter.lastName	String	The last or business name of the submitter.
submitter.firstName	String	The first name of the submitter.
submitter.middleName	String	The middle name of the submitter.
submitter.suffix	String	The suffix of the submitter.
submitter.id	String	The identifier of the submitter.
submitter.contactName	String	The contact name of the submitter.
submitter.phone	String	The phone number of the submitter.
submitter.extension	String	The phone extension of the submitter.
submitter.fax	String	The fax number of the submitter.
submitter.email	String	The email of the submitter.
payer	Object	An object representing the health plan of the patient.
payer.id	String	The Availity id of the health plan.
payer.name	String	The name of the health plan.
payer.claimFilingIndicatorCode	String	The claim filing indicator code for the type of insurance.
billingProvider	Object	An object representing the billing provider of the claim.
billingProvider.specialtyCode	String	The claim filing indicator code for the type of insurance.
billingProvider.name	String	The business name of the billing provider.
billingProvider.npi	String	The national provider id of the billing provider.
billingProvider.addressLine1	String	The first line of the address of the billing provider.
billingProvider.addressLine2	String	The second line of the address of the billing provider.
billingProvider.city	String	The city of the billing provider.
billingProvider.stateCode	String	The code of the state of the billing provider.
billingProvider.zipCode	String	The ZIP code of the billing provider.
billingProvider.ein	String	The employer identification number of the billing provider.
billingProvider.payerAssignedProviderId	String	The payer assigned provider id of the billing provider.
billingProvider.contactName	String	The contact name of the billing provider.
billingProvider.phone	String	The phone number of the billing provider.
billingProvider.extension	String	The phone extension of the billing provider.
billingProvider.fax	String	The fax number of the billing provider.
billingProvider.email	String	The email of the billing provider.
billingProvider.payTo.addressLine1	String	The first line of the address for the pay to of the billing provider.
billingProvider.payTo.addressLine2	String	The second line of the address for the pay to of the billing provider.
billingProvider.payTo.city	String	The city of the pay to of the billing provider.
billingProvider.payTo.stateCode	String	The code of the state for the pay to of the billing provider.
billingProvider.payTo.zipCode	String	The ZIP code for the pay to of the billing provider.
subscriber	Object	An object representing the subscriber of the claim.
subscriber.lastName	String	The last or business name of the subscriber.
subscriber.firstName	String	The first name of the subscriber.
subscriber.middleName	String	The middle name of the subscriber.
subscriber.suffix	String	The suffix of the subscriber.
subscriber.memberId	String	The member id of the subscriber.
subscriber.groupNumber	String	The group number of the subscriber.
subscriber.groupName	String	The group name of the subscriber.
subscriber.addressLine1	String	The first line of the address of the subscriber.
subscriber.addressLine2	String	The second line of the address of the subscriber.
subscriber.city	String	The city of the subscriber.
subscriber.stateCode	String	The code of the state of the subscriber.
subscriber.zipCode	String	The ZIP code of the subscriber.
subscriber.totalFamilyDeductible	String	The total family deductible dollar amount for the health care plan.
subscriber.accumulatedFamilyDeductible	String	The accumulated family deductible dollar amount for the health care plan.
subscriber.remainingFamilyDeductible	String	The remaining family deductible dollar amount for the health care plan.
subscriber.totalDeductible	String	The total individual deductible dollar amount for this health care plan.
subscriber.accumulatedDeductible	String	The accumulated individual deductible dollar amount for this health care plan.
subscriber.remainingDeductible	String	The remaining individual deductible dollar amount for this health care plan.
subscriber.onHold	Boolean	Indicates whether a subscriber is on hold.
subscriber.holdReasons	Object Array	An array of hold reasons for the claim.
subscriber.holdReasons.code	String	A code indicating the hold reason.
subscriber.holdReasons.description	String	A description for why the hold is in place.
patient	Object	An object representing the patient of the claim.
patient.lastName	String	The last or business name of the patient.
patient.firstName	String	The first name of the patient.
patient.middleName	String	The middle name of the patient.
patient.suffix	String	The suffix of the patient.
patient.addressLine1	String	The first line of the address of the patient.
patient.addressLine2	String	The second line of the address of the patient.
patient.city	String	The city of the patient.
patient.stateCode	String	The code of the state of the patient.
patient.zipCode	String	The ZIP code of the patient.
patient.birthDate	Date	The birth date of the patient.
patient.gender	String	A description of the gender of the patient.
patient.genderCode	String	A code representing the gender of the patient.
patient.subscriberRelationship	String	A description of the patient's relationship to the subscriber.
patient.subscriberRelationshipCode	String	A code representing the patient's relationship to the subscriber.
claimInformation	Object	An object representing the claim information of the claim.
claimInformation.controlNumber	String	A unique reference identifier provided by the submitter that was provided in the original claim status request.
claimInformation.facilityTypeCode	String	A code representing where services may be performed.
claimInformation.frequencyTypeCode	String	A code specifying the frequency of the claim.
claimInformation.providerAcceptAssignmentCode	String	A code indicating whether the provider accepts assignment.
claimInformation.benefitsAssignmentCertification	String	A code indicating assignment of benefits for a claim.
claimInformation.informationReleaseCode	String	A code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations.
claimInformation.admissionTypeCode	String	A code indicating the priority of this admission.
claimInformation.admissionSourceCode	String	A code indicating the source of this admission.
claimInformation.patientStatusCode	String	A code indicating patient status as of the "statement covers through date".
claimInformation.bundled	Boolean	Indicating whether the payer believes that the actual services performed and reported must be paid under only one procedure code.
claimInformation.displayMessage	String	The display message a payer may return.
claimInformation.principalDiagnosis	Object	An object representing the principal diagnosis code for the claim.
claimInformation.principalDiagnosis.qualifier	String	The description of the qualifier indicating what type of diagnosis code is used.
claimInformation.principalDiagnosis.qualifierCode	String	A code representing the qualifier indicating what type of diagnosis code is used.
claimInformation.principalDiagnosis.presentOnAdmissionIndicatorCode	String	Identifies the diagnosis onset as it relates to the diagnosis code.
claimInformation.otherDiagnoses	Object Array	An array representing the other diagnosis codes for the claim.
claimInformation.otherDiagnoses.qualifier	String	The description of the qualifier indicating what type of diagnosis code is used.
claimInformation.otherDiagnoses.qualifierCode	String	A code representing the qualifier indicating what type of diagnosis code is used.
claimInformation.otherDiagnoses.presentOnAdmissionIndicatorCode	String	Identifies the diagnosis onset as it relates to the diagnosis code.
claimInformation.principalProcedure	Object	An object representing the principal procedure code for the claim.
claimInformation.principalProcedure.qualifier	String	The description of the qualifier indicating what type of procedure code is used.
claimInformation.principalProcedure.qualifierCode	String	A code representing the qualifier indicating what type of procedure code is used.
claimInformation.principalProcedure.code	String	A code respresenting the procedure performed.
claimInformation.otherProcedures	Object Array	An array representing the other procedure codes for the claim.
claimInformation.otherProcedures.qualifier	String	The description of the qualifier indicating what type of procedure code is used.
claimInformation.otherProcedures.qualifierCode	String	A code representing the qualifier indicating what type of procedure code is used.
claimInformation.otherProcedures.code	String	A code representing the procedure performed.
claimInformation.serviceLines	Object Array	An array of service lines for the claim.
claimInformation.controlNumber	String	A unique reference identifier provided by the submitter that was provided in the original claim status request.
claimInformation.serviceLines.fromDate	String	The start date of the service.
claimInformation.serviceLines.toDate	String	The end date of the service.
claimInformation.serviceLines.revenueCode	String	The identifying number for a product or service.
claimInformation.serviceLines.procedure	Stirng	The description of the procedure performed.
claimInformation.serviceLines.procedureCode	String	A code respresenting the procedure performed.
claimInformation.serviceLines.modifierCode1	String	A description of the first modifier applied to this procedure.
claimInformation.serviceLines.modifierCode2	String	A description of the second modifier applied to this procedure.
claimInformation.serviceLines.modifierCode3	String	A description of the third modifier applied to this procedure.
claimInformation.serviceLines.modifierCode4	String	A description of the forth modifier applied to this procedure.
claimInformation.serviceLines.amount	String	This total charge amount for this service line. The amount is inclusive of the provider’s base charge and any applicable tax and/or postage claimed amounts.
claimInformation.serviceLines.quantity	String	The units of service.
claimInformation.serviceLines.quantityTypeCode	String	A code representing the quantity units.
claimInformation.serviceLines.estimatedPatientResponsibility	String	The estimated amount of the patient's responsibility.
claimInformation.serviceLines.bundlingDescription	String	The description from the payer if bundling was performed.
claimInformation.serviceLines.denyReason	String	The reason why the procedure is denied.
claimInformation.serviceLines.holdReasons	Object Array	An array of hold reasons for the procedure.
claimInformation.serviceLines.holdReasons.code	String	The hold reason code.
claimInformation.serviceLines.holdReasons.description	String	The hold reason description.
claimInformation.serviceLines.messages	Object Array	An array of messages for the procedure.
claimInformation.serviceLines.messages.code	String	The message code.
claimInformation.serviceLines.messages.description	String	The message description.
claimInformation.serviceLines.messages.procedure	String	The procedure for the message.
claimInformation.serviceLines.displayMessage	String	The display message a payer may return.
claimInformation.serviceLines.allowed	Object	An object representing the allowed portion of the procedure performed.
claimInformation.serviceLines.allowed.amount	String	The amount allowed for the procedure performed.
claimInformation.serviceLines.allowed.code	String	The code for the procedure performed.
claimInformation.serviceLines.allowed.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.allowed.description	String	The description of the allowed amount the procedure performed.
claimInformation.serviceLines.allowed.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.allowed.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.notCovered	Object	An object representing the not covered portion of the procedure performed.
claimInformation.serviceLines.notCovered.amount	String	The amount not covered for the procedure performed.
claimInformation.serviceLines.notCovered.code	String	The code for the procedure performed.
claimInformation.serviceLines.notCovered.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.notCovered.description	String	The description of the not covered amount the procedure performed.
claimInformation.serviceLines.notCovered.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.notCovered.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.coPay	Object	An object representing the copay portion of the procedure performed.
claimInformation.serviceLines.coPay.amount	String	The amount of copay for the procedure performed.
claimInformation.serviceLines.coPay.code	String	The code for the procedure performed.
claimInformation.serviceLines.coPay.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.coPay.description	String	The description of the copay amount the procedure performed.
claimInformation.serviceLines.coPay.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.coPay.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.coInsurance	Object	An object representing the co-insurance portion of the procedure performed.
claimInformation.serviceLines.coInsurance.amount	String	The amount of co-insurance for the procedure performed.
claimInformation.serviceLines.coInsurance.code	String	The code for the procedure performed.
claimInformation.serviceLines.coInsurance.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.coInsurance.description	String	The description of the co-insurance amount the procedure performed.
claimInformation.serviceLines.coInsurance.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.coInsurance.patientLiable	Boolean	Indicates whether the patient is liable.
claimInformation.serviceLines.deductible	Object	An object representing the deductible portion of the procedure performed.
claimInformation.serviceLines.deductible.amount	String	The amount of deductible for the procedure performed.
claimInformation.serviceLines.deductible.code	String	The code for the procedure performed.
claimInformation.serviceLines.deductible.codeType	String	A code type for the procedure performed.
claimInformation.serviceLines.deductible.description	String	The description of the deductible amount the procedure performed.
claimInformation.serviceLines.deductible.procedure	String	The procedure code of the procedure performed.
claimInformation.serviceLines.deductible.patientLiable	Boolean	Indicates whether the patient is liable.

POST /V1/INSTITUTIONAL-CLAIMS

This endpoint creates a CCE asynchronously. To submit a CCE, make a valid request and a response will be returned with a location header containing a URL you can query for your result.

RESPONSES

HTTP Status Code	Description
202	The CCE was accepted for processing. Poll the URL in the Location header. The X-Status-Message header will contain additional detail.
400	The CCE request failed validation. It either failed our validation rules or was rejected by the health plan. The errors property will contain detailed information. Errors that specify a field are Availity validation rule failures. Errors that specify a code are from the health plan. Correct the errors and resubmit the request.
500	We were unable to parse your request. Correct the errors and resubmit the request.

VALIDATION RULES

The validation rules for the InstitutionalClaim resource can vary by health plan, the type of claim being requested, and the type of service to be performed. Availity organizes these rules and makes them available through the Configuration service. The Configuration resource documents the fields you need to send to create a InstitutionalClaim and explains what values are valid for those fields. See the Configurations service for details.

EXAMPLES

If your request is invalid, we will respond with a status code of 400 and a list of errors for you to correct.

	$ curl -i -H "x-api-key: $API_KEY" -H "Content-Type: application/json" -X POST -d '{
	  "requestTypeCode": "PRE_DETERMINATION",
	  "billingProvider": {
		"npi": "1234567893",
		"ein": "111222333",
		"payerAssignedProviderId": "XYZ321"
	  },
	  "patient": {
		"relationshipCode": "01",
		"lastName": "Smith",
		"firstName": "Bob",
		"stateCode": "FL",
		"birthDate": "1980-02-12",
		"genderCode": "M"
	  },
	  "payer": {
		"id": "BCBSF"
	  },
	  "submitter": {
		"id": "123456789",
		"lastName": "SUBMITTER"
	  },
	  "subscriber": {
		"memberId": "JDH001",
		"groupName": "ASDF 1-2",
		"groupNumber": "12312412"
	  },
	  "claimInformation": {
		"principalDiagnosis": {
		  "code": "S52512A",
		  "qualifierCode": "ABK"
		},
		"serviceLines": [
		  {
			"procedureCode": "A4719",
			"quantity": "1.0",
			"amount": "10.00"
		  }
		]
	  }
	}' https://api.availity.com/demo/v1/institutional-claims
	
	HTTP/1.1 400 Bad Request
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json
	Date: Fri, 03 Jun 2016 18:19:16 GMT
	x-api-id: ad4dff7e-7d54-4388-8a80-ce4227cd702a
	X-Session-ID: ad4dff7e-7d54-4388-8a80-ce4227cd702a
	Connection: close
	
	{
	  "userMessage" : "Your request was invalid.",
	  "developerMessage" : "The request was invalid. See the 'errors' property for details.",
	  "reasonCode" : 0,
	  "statusCode" : 400,
	  "errors" : [ {
		"field" : "claimInformation.facilityTypeCode",
		"errorMessage" : "Enter a valid Bill Type.",
		"index" : 0,
		"nestedEntityErrors" : [ ]
	  }, {
		"field" : "claimInformation.serviceLines.fromDate",
		"errorMessage" : "Enter an as of date up to 24 months in the past and up to 12 months in the future.",
		"index" : 0,
		"nestedEntityErrors" : [ ]
	  }, {
		"field" : "claimInformation.serviceLines.revenueCode",
		"errorMessage" : "Enter a valid Revenue Code.",
		"index" : 0,
		"nestedEntityErrors" : [ ]
	  } ]
	}

If your request is valid, we will respond with a status code of 202 and a location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -i -H "x-api-key: $API_KEY" -H "Content-Type: application/json" -X POST -d '{
	  "requestTypeCode": "PRE_DETERMINATION",
	  "billingProvider": {
		"npi": "1234567893",
		"ein": "111222333",
		"payerAssignedProviderId": "XYZ321"
	  },
	  "patient": {
		"relationshipCode": "01",
		"lastName": "Smith",
		"firstName": "Bob",
		"stateCode": "FL",
		"birthDate": "1980-02-12",
		"genderCode": "M"
	  },
	  "payer": {
		"id": "BCBSF"
	  },
	  "submitter": {
		"id": "123456789",
		"lastName": "JOHNSON"
	  },
	  "subscriber": {
		"memberId": "JDH001",
		"groupName": "ASDF 1-2",
		"groupNumber": "12312412"
	  },
	  "claimInformation": {
		"facilityTypeCode": "13",
		"principalDiagnosis": {
		  "code": "S52512A",
		  "qualifierCode": "ABK"
		},
		"serviceLines": [
		  {
			"revenueCode": "0360",
			"procedureCode": "A4719",
			"quantity": "1.0",
			"amount": "10.00",
			"fromDate": "2016-05-10"
		  }
		]
	  }
	
	}' https://api.availity.com/demo/v1/institutional-claims
	
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Fri, 03 Jun 2016 20:00:40 GMT
	Location: https://api.availity.com/demo/v1/institutional-claims/-465960752822731184
	x-api-id: 893ef842-5ec0-4223-8338-ab31bdd25c90
	X-Session-ID: 893ef842-5ec0-4223-8338-ab31bdd25c90
	X-Status-Message: We are processing your request.
	Connection: close

GET /V1/INSTITUTIONAL-CLAIMS/:ID

You can retrieve a CCE using this endpoint.

RESPONSES

HTTP Status Code	Description
200	We are done processing your request and the response body contains the result.
202	We are currently processing your request. We may be retrying it.
400	Your CCE request failed validation. You can correct the errors and resubmit.
404	We did not find a InstitutionalClaim with the id that you sent.
504	We were unable to process your request. The health plan did not respond after several retry attempts. Please try your request again later.

EXAMPLES

You can request the URI that was returned in the Location response header during from your POST request. If the resource is found but we have not received a response from the health plan, we will respond with a status code of 202 and a Location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/institutional-claims/-465960752822731184
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Mon, 06 Jun 2016 18:11:34 GMT
	Location: https://api.availity.com/demo/v1/institutional-claims/-465960752822731184
	x-api-id: 25a71361-7f75-4dc9-918b-021e163b0df8
	X-Session-ID: 25a71361-7f75-4dc9-918b-021e163b0df8
	X-Status-Message: The health plan did not respond. We are retrying the request.
	Connection: close

Once we have a response from the health plan, we will respond with a status code of 200 and a InstitutionalClaim resource. This example shows what a response looks like when the health plan is unable to determine a patients liability.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/institutional-claims/-465960752822731184
	->
	HTTP/1.1 200 OK
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Mon, 06 Jun 2016 18:35:19 GMT
	x-api-id: 22d78708-6094-4e95-a8fe-3bb762975fd3
	X-Availity-Transaction-ID: 1613032
	X-Session-ID: 22d78708-6094-4e95-a8fe-3bb762975fd3
	Connection: close
	Server: Jetty(8.1.17.v20150415)
	
	{
	  "id" : "-5375712665050195544",
	  "createdDate" : "2016-07-06T14:35:07.000+0000",
	  "updatedDate" : "2016-07-06T14:35:08.000+0000",
	  "expirationDate" : "2016-07-07T14:35:07.000+0000",
	  "requestTypeCode" : "PRE_DETERMINATION",
	  "submitter" : {
		"lastName" : "JOHNSON",
		"id" : "123456789"
	  },
	  "payer" : {
		"id" : "BCBSF"
	  },
	  "billingProvider" : {
		"ein" : "111222333",
		"payerAssignedProviderId" : "G1234"
	  },
	  "subscriber" : {
		"memberId" : "JBTEST1",
		"onHold" : false
	  },
	  "patient" : {
		"lastName" : "SMITH",
		"firstName" : "JOE",
		"birthDate" : "1870-01-01",
		"gender" : "Male",
		"genderCode" : "M",
		"subscriberRelationship" : "Spouse",
		"subscriberRelationshipCode" : "01"
	  },
	  "claimInformation" : {
		"facilityTypeCode" : "13",
		"frequencyTypeCode" : "1",
		"messages" : [ {
		  "code" : "EAPI-90386",
		  "description" : " Plan profile information not found"
		} ],
		"displayMessage" : "Unable to determine patient liability; additional information is required. For assistance, contact BCBSF",
		"principalDiagnosis" : {
		  "qualifier" : "International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis",
		  "qualifierCode" : "ABK",
		  "code" : "G912"
		}
	  }
	}

POST /V1/DENTAL-CLAIMS

This endpoint creates a dental claim asynchronously. To submit a dental claim, make a valid request and a response will be returned with a location header containing a URL you can query for your result.

RESPONSES

HTTP Status Code	Description
202	The claim was accepted for processing. Poll the URL in the Location header. The X-Status-Message header will contain additional detail.
200	The claim has completed processing and will be submitted to the health plan.
400	The claim request failed validation. It either failed our validation rules or was rejected by the health plan. The errors property will contain detailed information. Errors that specify a field are Availity validation rule failures. Errors that specify a code are from the health plan. Correct the errors and resubmit the request.
500	We were unable to parse your request. Correct the errors and resubmit the request.

VALIDATION RULES

The validation rules for the DentalClaim resource can vary by health plan, the type of claim being requested, and the type of service to be performed. Availity organizes these rules and makes them available through the Configuration service. The Configuration resource documents the fields you need to send to create a DentalClaim and explains what values are valid for those fields. See the Configurations service for details.

EXAMPLES

If your request is invalid, we will respond with a status code of 400 and a list of errors for you to correct.

	$ curl -i -H "x-api-key: $API_KEY" -H "Content-Type: application/json" -X POST -d ' {
		"requestTypeCode": "CLAIM",
		"submitter": {
			"lastName": "AVAILITY",
			"id": "111222333",
			"phone": "9045556666"
		},
		"payer": {
			"id": "00611",
			"claimFilingIndicatorCode": "BL"
		},
		"billingProvider": {
			"ein": "111222333",
			"lastName": "ASDF",
			"npi": "1234567893",
			"addressLine1": "123 main st",
			"city": "Jacksonville",
			"stateCode": "FL",
			"zipCode": "322231234",
			"countryCode": "US",
			"specialtyCode": "282N00000X"
		},
		"patient": {
			"lastName": "smith",
			"firstName": "bob",
			"addressLine1": "123 main st",
			"city": "Jacksonville",
			"stateCode": "FL",
			"zipCode": "322231234",
			"genderCode": "M",
			"birthDate": "2001-01-01"
		},
		"claimInformation": {
			"diagnoses": [{
				"qualifierCode": "ABK",
				"code": "J3089"
			}],
			"providerSignatureOnFile": true,
			"frequencyTypeCode": "1",
			"informationReleaseCode": "I",
			"placeOfServiceCode": "11",
			"providerAcceptAssignmentCode": "A",
			"serviceFromDate": "2016-07-22",
			"serviceLines": [{
				"amount": "0.01",
				"diagnosisCodePointer1": "1",
				"procedureCode": "D0120",
				"treatmentStartDate": "2016-07-22"
			}]
		}
	}' https://api.availity.com/demo/v1/dental-claims
	
	HTTP/1.1 400 Bad Request
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json
	Date: Fri, 14 Oct 2016 18:19:16 GMT
	x-api-id: c1585584-5d6f-472e-9e8e-f4300b6f237c
	X-Session-ID: c1585584-5d6f-472e-9e8e-f4300b6f237c
	Connection: close
	
	{
	  "userMessage": "Your request was invalid.",
	  "developerMessage": "The request was invalid. See the 'errors' property for details.",
	  "reasonCode": 0,
	  "statusCode": 400,
	  "errors": [
		{
		  "field": "subscriber.memberId",
		  "errorMessage": "Enter a valid alphanumeric Member ID. Punctuation and special characters are not allowed.",
		  "index": 0
		}
	  ]
	}

If your request is valid, we will respond with a status code of 202 and a location header where you can check back for your response. We will continue to respond in this way until we have completed processing the request.

	$ curl -i -H "x-api-key: $API_KEY" -H "Content-Type: application/json" -X POST -d ' {
		"requestTypeCode": "CLAIM",
		"submitter": {
			"lastName": "AVAILITY",
			"id": "111222333",
			"phone": "9045556666"
		},
		"payer": {
			"id": "00611",
			"claimFilingIndicatorCode": "BL"
		},
		"billingProvider": {
			"ein": "111222333",
			"lastName": "ASDF",
			"npi": "1234567893",
			"addressLine1": "123 main st",
			"city": "Jacksonville",
			"stateCode": "FL",
			"zipCode": "322231234",
			"countryCode": "US",
			"specialtyCode": "282N00000X"
		},
		"subscriber": {
			"memberId": "ABC1234"
		},
		"patient": {
			"lastName": "smith",
			"firstName": "bob",
			"addressLine1": "123 main st",
			"city": "Jacksonville",
			"stateCode": "FL",
			"zipCode": "322231234",
			"genderCode": "M",
			"birthDate": "2001-01-01"
		},
		"claimInformation": {
			"diagnoses": [{
				"qualifierCode": "ABK",
				"code": "J3089"
			}],
			"providerSignatureOnFile": true,
			"frequencyTypeCode": "1",
			"informationReleaseCode": "I",
			"placeOfServiceCode": "11",
			"providerAcceptAssignmentCode": "A",
			"serviceFromDate": "2016-07-22",
			"serviceLines": [{
				"amount": "0.01",
				"diagnosisCodePointer1": "1",
				"procedureCode": "D0120",
				"treatmentStartDate": "2016-07-22"
			}]
		}
	}' https://api.availity.com/demo/v1/dental-claims
	
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Fri, 14 Oct 2016 18:20:32 GMT
	Location: https://api.availity.com/demo/v1/dental-claims/12345
	x-api-id: d9cf9b22-a0f6-4179-89f3-14a3909b40f7
	X-Session-ID: d9cf9b22-a0f6-4179-89f3-14a3909b40f7
	X-Status-Message: We are processing your request.
	Connection: close

GET /V1/DENTAL-CLAIMS/:ID

You can retrieve a dental claim using this endpoint.

RESPONSES

HTTP Status Code	Description
200	We are done processing your request and the response body contains the result.
202	We are currently processing your request. We may be retrying it.
404	We did not find a ProfessionalClaim with the id that you sent.

EXAMPLES

You can request the URI that was returned in the Location response header during from your POST request. If the resource is found but we have not received a response from the health plan, we will respond with a status code of 202 and a Location header where you can check back for your response. We will continue to respond in this way until we have heard back from the health plan.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/dental-claims/12345
	->
	HTTP/1.1 202 Accepted
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Mon, 06 Jun 2016 18:11:34 GMT
	Location: https://api.availity.com/demo/v1/dental-claims/12345
	x-api-id: 1cea8eb0-35fa-4c32-bfa5-5aade9d46ef6
	X-Session-ID: 1cea8eb0-35fa-4c32-bfa5-5aade9d46ef6
	X-Status-Message: We are processing your request.
	Connection: close

Once we have completed processing the dental claim we'll sumbit it to the health plan, we will respond with a status code of 200 and a resource letting you know the claim was accepted.

	$ curl -H "x-api-key: $API_KEY" -X GET -i https://api.availity.com/demo/v1/professional-claims/12345
	->
	HTTP/1.1 200 OK
	Cache-Control: private,no-store,max-age=0,must-revalidate
	Content-Type: application/json;charset=utf-8
	Date: Mon, 06 Jun 2016 18:35:19 GMT
	x-api-id: ae25a482-1954-4725-b72b-7a686f03f27c
	X-Availity-Transaction-ID: 1613032
	X-Session-ID: ae25a482-1954-4725-b72b-7a686f03f27c
	Connection: close
	
	{
	  "links": {
		"self": {
		  "href": "https://api.availity.com/demo/v1/dental-claims/12345"
		}
	  },
	  "id": "12345",
	  "createdDate": "2016-10-10T12:29:19.000+0000",
	  "updatedDate": "2016-10-10T12:29:19.000+0000",
	  "expirationDate": "2016-10-11T12:29:19.000+0000",
	  "message": "Your claim has been accepted for processing. Check your EDI files."
	}

Availity Payer List

 

 

The Availity Payer List service allows you to see which payers and transactions for each type of data submission are available to you based on your Availity contract.  You can also see when changes to availability or costs are coming up.

The Resource

Parameter	Type	Description
name	String	The common name identifying the health plan
payerId	String	A unique identifier used to communicate with the payer
displayName	String	The name displayed on Availity Essentials for the payer
shortName	String	A shortened name for the payer used in the file naming convention for batch transactions.
processingRoutes	Object	A list of the routes available for communication from Availity to the payer
transactionDescription	String	Describes the type of transaction for the route (ex. Eligibility and Benefits)
submissionMode	String	Describes how the data is submitted to Availity (ex. Portal, Batch).
effectiveDate	String	The date the transaction became available.
availability	String	Indicates whether the transaction is available to the user under their current contract or requires an additional Availity contract. Note this refers to the Availity contract not the payer.
enrollmentRequired	Boolean	Indicates whether enrollment with Availity is required in order to submit the transaction.
enrollmentMode	String	Indicates what type of enrollment is required with Availity (ex. Paper enrollment mode indicates additional paperwork must be submitted to the payer to complete the enrollment process).
additionalInfo	String	Additional information about the transaction if any.
rebateTier	String	The cost tier of the route
passThroughRate	String	The pass through rate of the route.
newTierNotice	String	The notice of upcoming tier change.
gateway	String	The designation if Availity is the gateway for this payer.
recentlyAdded	String	The date when the route was added.

 

GET v1/availity-payer-list

You can search for payer information using this endpoint. The following optional parameters allow you to filter the list of payers to those or support at least one route that meets the given route filters.

Parameters

Parameter	Type	Description
payerID	String	ID that identifies the payer at Availity (e.g. 00590)
transactionType	String	HIPAA identifier for a transaction. Accepted Values: 270 276 278  278I 835 837P 837PEncounter 837PPredetermination 837I 837IEncounter 837IPredetermination 837DEncounter 837DPredetermination 277RFAI 275 278N CCE
submissionMode	String	Describes how the data is submitted to Availity (ex. Portal, Batch). Accepted Values: Portal Batch RealTime API
enrollmentRequired	Boolean	Indicates whether enrollment with Availity is required in order to submit the transaction.
contractRequired	String	Indicates whether an additional Availity contract is required to submit a transaction. Accepted Values: available contract required