• HTML: for use in HTML entities

• HTML_ATTRIBUTE: for use in HTML attribute values

• CSS: for use in stylesheets and style tags

• URL: for use in a URL

• JAVA_SCRIPT: for use in JavaScript data values

• XML: for use in XML entities

• XML_ATTRIBUTE: for use in XML attribute values

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."

{
  "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"
    },
    {
        ...
    }
  ]
}

• 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.

The links field contains link relations depending on the page and number of resources returned. When a link relation is not available, you receive a null value when trying to access it.

Link relation	Definition	HREF
self	URL used to retrieve the collection resources.	https://api.availity.com/availity/v1/coverages?offset=50&limit=50"
first	URL to retrieve the first page of resources.	https://api.availity.com/availity/v1/coverages?offset=0&limit=50"
last	URL to retrieve the last page of resources.	https://api.availity.com/availity/v1/coverages?offset=251&limit=50"
next	URL to retrieve the next page of resources.	https://api.availity.com/availity/v1/coverages?offset=100&limit=50"
prev	URL to retrieve the previous page of resources.	https://api.availity.com/availity/v1/coverages?offset=0&limit=50"

Parameter	Type	Definition
payerId	Query string (optional)	The payer's Availity-specific identifier.
transactionType	Query array (optional)	The code identifying the EDI/HIPAA transaction(s) supported by a payer. Accepted values include the following (definitions are in parentheses): 270 (Eligibility Benefit Inquiry) 276 (Claim Status Request) 278I (Service Review Inquiry) 835 (Claim Payment/Advice) 837P (Claim: Professional) 837PEncounter (Encounter: Professional) 837PPredetermination (Predetermination: Professional) 837I (Claim: Institutional) 837IEncounter (Encounter: Institutional) 837IPredetermination (Predetermination: Instutional) 837D (Dental Claim) 837DEncounter (Dental Encounter) 837DPredetermination (Dental Predetermination) 277RFAI (Claim Request for Additional Information) 275 (Medical Attachments) 278N (Notice of admission) ClaimStatusSummary (Enhanced Claim Status summarySearch) ClaimStatusDetail (Enhanced Claim Status detailSearch) ClaimStatusValueAdd (Enhanced Claim Status valueAdd277)
submissionMode	Query array (optional)	The method of submission for the transaction(s) supported by a payer. Accepted values: Portal, Batch, RealTime, and API.
availability	Query string (optional)	Accepted values: availability=available (returns payers that do not require an Availity contract) and availability=contractrequired (returns payers that require an Availity contract).
enrollmentRequired	Query boolean (optional)	Allows you to filter whether enrollment is required for any payer transaction.
Accept	Header string (optional)	Allows you to specify application.json

curl --request GET \
  --url 'https://api.availity.com/availity/v1/availity-payer-list?payerId=591209257&transactionType=276&submissionMode=PORTAL
&availability=AVAILABLE&enrollmentRequired=true' \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application.json'

[
  {
    "name": "Brian Wilkins",
    "payerId": "591209257",
    "displayName": "Addie Hoffman",
    "shortName": "Jay Garza",
    "processingRoutes": {
      "transactionDescription": "Javauh baele caf wug etaaf sa kispa girhamok remowloj tu mu tob iteno ijri sevonler ori anu.",
      "submissionMode": "portal",
      "effectiveDate": "10/11/2030",
      "availability": false,
      "enrollmentRequired": false,
      "enrollmentMode": "paper enrollment",
      "additionalInfo": "rozteddawdes",
      "rebateTier": "ufufenagazaz",
      "passThroughRate": "kipcekvevzelepu",
      "newTierNotice": "jadjuzt",
      "gateway": "gocrifakoriw",
      "recentlyAdded": "vopadcezaenouvc"
    }
  }
]

Payer List response definitions: Primary fields and objects
Field	Type	Definition
name	String	The common name for the health plan.
payerID	String	The payer's Availity-specific identifier.
displayName	String	The payer's name as displayed on Availity Essentials.
shortName	String	The payer's shortened name used in the file naming convention for batch transactions.
processingRoutes	Object	Object providing information about the routes available for communication from Availity to the payer. See the processingRoutes table for field definitions.

Payer List response definitions: Fields within processingRoutes
Field	Type	Definition
transactionDescription	String	Describes the HIPAA transaction type. See the transactionType parameter for possible values.
submissionMode	String	The method of submission for the transaction(s) supported by a payer. Possible values: Portal, Batch, RealTime, and API.
effectiveDate	String	The date the transaction became available for this payer.
availability	Boolean	Indicates whether the transaction is available to the payer under its current Availity contract or requires an additional Availity contract.
enrollmentRequired	Boolean	Indicates whether enrollment with Availity is required to submit the transaction.
enrollmentMode	String	Indicates the type of enrollment required with Availity. Possible values: Manual Payer Submission Paperless Payer Portal Enrollment Paper Email Attachment Auto Complete
additionalInfo	String	Provides additional information about the transaction, if applicable.
rebateTier	String	The processing route's cost tier.
passThroughRate	String	The processing route's pass-through rate.
newTierNotice	String	Provides notice of an upcoming tier change, if applicable.
gateway	String	The designation if Availity is the gateway for this payer for this route.
recentlyAdded	String	The date the route was added.

Parameter	Type	Definition
type	Query string (required)	Indicate the type of HIPAA transaction for the configuration you're requesting. Refer to the Validation rules subsection in each applicable API's reference section or the table below for accepted values.
subtypeId	Query string (optional)	The subtype ID for your request. Refer to the Validation rules subsection in each applicable API's reference section or the table below for accepted values.
payerId	Query string (optional)	A health plan's Availity-specific identifier.
Accept	Header string (optional)	Allows you to specify application/json or application/xml.

Healthcare Transactions API	type value	subtypeId value
Coverages Send the type parameter without specifying a payerId for a list of all payers that support the Coverages API. Send type with the payerId to return the validation rules for this API for a specific payer.	270	–
Service Reviews This type name allows you to search for validation rules and parameter list for the POST/v2/service-reviews request. Sending the type, subtypeId, and payerIdparameters returns the validation rules and parameter list for Service Reviews for a specific payer.	service-reviews	HS (outpatient authorization) AR (inpatient authorization/admission review) SC (referral)
Service Reviews This type name allows you to search for validation rules and parameter list for the GET/v2/service-reviews request.	service-reviews-inquiry	HS (outpatient authorization) AR (inpatient authorization/admission review) SC (referral)
Claim Statuses Send the type parameter without specifying a payerId for a list of all payers that support the Claim Statuses API. Specify type and payerId to return the validation rules for a specific payer.	claim-statuses-inquiry	–
Care Cost Estimator – Professional Send the type parameter without specifying a payerId for a list of all payers that support the CCE – Professional API. Specify type and subtypeId with the payerId to return the validation rules for a specific payer.	professional-claims	PRE_DETERMINATION
Care Cost Estimator – Institutional Send the type parameter without specifying a payerId for a list of all payers that support the CCE – Institutional API. Specify type and subtypeId with the payerId to return the validation rules for a specific payer.	institutional-claims	PRE_DETERMINATION
Dental Claims Send the type parameter without specifying a payerId for a list of all payers that support the Dental Claims API. Specify type and subtypeId with the payerId to return the validation rules for a specific payer.	dental-claims	CLAIM ENCOUNTER PRE_DETERMINATION
Enhanced Claim Status Send the type parameter without specifying a payerId for a list of all payers that support the Enhanced Claim Status API. Specify type and subTypeId with the payerId to return the validation rules for a specific payer for a particular Enhanced Claim Status search.	enhanced-claim-status	HIPAA_276 VALUE_ADDS_277 SUMMARY DETAIL

curl -X GET "https://api.availity.com/availity/v1/configurations?payerId=BCBSF&type=270" 

{
  "totalCount": 27734645,
  "count": 38099164,
  "offset": 50559072,
  "limit": 93842940,
  "links": {
    "id": 5689220412735488
  },
  "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
        }
      }
    }
  ]
}

Configurations response definitions: Primary result set
Field	Type	Definition
totalCount	Integer	Total number of assets.
count	Integer	Number of assets in the result set.
offset	Integer	Paging offset.
limit	Integer	Paging limit.
links	Object	Object containing a set of resource URIs.
configurations	Array	Array providing configurations by type, subTypeId, and/or payerId. See the Configurations table for field definitions.

Configurations response definitions: Fields within configurations
Field	Type	Definition
type	String	The type of HIPAA transaction for which you requested configurations.
categoryId	String	The configuration category ID.
categoryValue	String	The configuration category value.
subtypeId	String	The subtype ID specified in your request.
subtypeValue	String	The subtype value specified in your request.
payerId	String	The Availity-specific payer identifier for this configuration.
payerName	String	The name of the health plan that this configuration request involves.
version	String	The configuration version. Values include the following for Enhanced Claim Status: HIPAA_276 (searchBy276) VALUE_ADDS_277 (valueAdds277) CLAIM_HISTORY (summarySearch) SERVICE_DATE (summarySearch) CHECK_NUMBER (summarySearch) MEMBER_ID (summarySearch) CLAIM_NUMBER (detailSearch)
sourceId	String	The configuration source ID.
elements	Object	Object providing information about each of the elements that make up the health plan's configuration form and indicating whether and under what conditions those elements are supported. See the Elements table for field definitions.
requiredFieldCombinations	Array	Array providing information about field combinations required by the health plan. Each entry defines a rule where all fields in at least one of the lists of fields must be provided.
settings	Object	Object providing information about key-value settings.

Configurations response definitions: Fields within elements
Field	Type	Definition
type	String	The data type for this element that maps to the type of element displayed in your UI. Not to be confused with the type parameter. Accepted values: Unsupported (not shown in UI) Boolean (checkmark) Collection (searchable REST-backed drop-down) Date (date picker) Enumeration (searchable inline drop-down) Information (text) Section (grouper or container with text) Text (standard text box) Number (text box serialized as numeric) Object (grouping as in Section, but with additional metadata) ObjectArray (repeating grouping with additional metadata)
label	String	The name used for display in your application's UI.
order	Integer	An optional ordering index you can use to lay out fields in your application's UI.
helpTopicId	String
elements	Object	Child elements.
errorMessage	String	An error message you can use in your application's UI if this element does not pass validation. You can use this message if you perform client-side validation or after you've submitted a request and it returns as invalid.
maxRepeats	Integer	Maximum number of item repetitions.
allowed	Boolean	Indicates whether the element is valid to use.
required	Boolean	Indicates whether the element is required.
information	Array	A list of information.
groups	Array	A list of groups.
repeats	Boolean	Indicates whether the item repeats.
hidden	Boolean	Indicates whether the item is hidden.
minRepeats	Integer	Minimum number of item repetitions.
defaultValue	String	A default value you can use for pre-populating a field in your application's UI.
values	String	A list of values.
valuesWhen	Object	Conditional values.
min	String (date)	Minimum date.
max	String (date)	Maximum date.
pattern	String	A regular expression you can use to validate input parameter values.
maxLength	Integer	The maximum character length allowed for this element.
minLength	Integer	The minimum character length allowed for this element.
maxLengthWhen	Object	Conditional maximum length. Refer to the elements—Conditional fields table for field definitions.
patternWhen	Object	Conditional pattern. Refer to the elements—Conditional fields table for field definitions.
mode	String	Indicates whether the element uses a drop-down list or radio button group.
allowedWhen	Object	Object indicating the conditions under which the element is allowed. Refer to the elements—Conditional fields table for field definitions.
notAllowedWhen	Object	Object indicating the conditions under which the element is not allowed. Refer to the elements—Conditional fields table for field definitions.
requiredWhen	Object	Object indicating the conditions under which the element is required. Refer to the elements—Conditional fields table for field definitions.
notRequiredWhen	Object	Object indicating the conditions under which the element is not required. Refer to the elements—Conditional fields table for field definitions.
objectTypes	Object	Object array item type prototype definitions. See the elements.objectTypes table for field definitions.

Configurations response definitions: Fields within elements—Conditional fields
Field	Type	Definition
equalTo	String	Applies when the element value is equal to this value.
containedIn	Array	Applies when the field value is in the list.
greaterThan	String	Applies when the field value is greater than this value.
lessThan	String	Applies when the field value is less than this value.
greaterEqual	String	Applies when the field value is greater than or equal to this value.
lessEqual	String	Applies when the field value is less than or equal to this value.
maxLength	Integer	Maximum character length.
pattern	Integer	A regular expression you can use to validate input parameter values.
values	?	Possible values or link to possible values.

Configurations response definitions: Fields within elements.objectTypes
Field	Type	Definition
label	String	A label for this object type.
minInstances	Integer	The minimum number of instances of this type of object.
maxInstances	Integer	The maximum number of instances of this type of object.
required	Boolean	Indicates whether the object is required.
allowedWhen	Object	Object type is allowed when one condition is true.
notAllowedWhen	Object	Object type is not allowed when one condition is true.
requiredWhen	Object	Object type is required when one condition is true.
notRequiredWhen	Object	Object type is not required when one condition is true.
fieldValues	Object	Object type discriminators.

	Path	Function
1	GET/v1/coverages	Retrieve a snapshot of a member's health plan coverage by querying the resource with certain parameters. You can also search your recent coverage requests with this endpoint.
2	GET/v1/coverages/{id}	Retrieve details about a specific member's coverage by requesting coverage by ID number. Replace {id} with the response ID from your initial request.
3	DELETE/v1/coverages/{id}	Delete a specific coverage by sending a DELETE request by ID number. Replace {id} with the response ID from your initial request.

To test the demo version of this API, send the X-Api-Mock-Scenario-ID header with the appropriate response scenario ID, as listed in the following table.

Coverages demo response scenarios
Response scenario ID	Status code	Definition
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.

Although none of the Coverages request parameters are required by the API, it is a good idea to send as many fields as you can. Requirements vary by health plan, as noted in the table below.

GET/v1/coverages parameters
Parameter	Type	Description
payerId	Query string (optional)	The Availity-specific identifier for the patient's health plan.
providerLastName	Query string (optional)	The requesting provider's last name.
providerFirstName	Query string (optional)	The requesting provider's first name.
providerType	Query string (optional)	Specify whether the health plan is professional or institutional, as required by some health plans.
providerNpi	Query string (optional)	The requesting provider's National Provider Identifier (NPI). Most health plans require the provider NPI for coverage requests.
providerTaxId	Query string (optional)	The requesting provider's tax ID, as required by some health plans.
payerAssignedProviderId	Query string (optional)	Some health plans allow you to specify a payer-assigned identifier for the requesting provider. If the payer has assigned the requesting provider an ID number, specify it using this parameter.
providerSSN	Query string (optional)	The requesting provider's Social Security Number (SSN), if required.
providerPIN	Query string (optional)	The requesting provider's personal identification number.
providerCity	Query string (optional)	Specify the requesting provider’s city, as required by some health plans.
providerState	Query string (optional)	Specify the requesting provider’s two-character state code, as required by some health plans.
providerZipCode	Query string (optional)	Specify the requesting provider’s ZIP code, as required by some health plans.
providerSpecialty	Query string (optional)	Specifies the requesting provider's specialty using a taxonomy code. Refer to X12 External Code Source 682: Provider Taxonomy Codes.
placeOfService	Query string (optional)	Identifies the place of service, as required by some health plans.
submitterId	Query string (optional)	Identifies the submitter using a payer-assigned submitter identifier, as required by some health plans.
asOfDate	Query string (optional)	Indicates the date of service for which you want to check coverage information.
toDate	Query string (optional)	Provides an end date for your coverage information search period, as required by some health plans.
serviceType	Query string (optional)	The type or types of service your request involves.
cardIssueDate	Query string (optional)	The issue date of the member's health plan card.
procedureCode	Query string (optional)	The procedure code for the coverage you're requesting. Refer to the ASC X12 270/271 TR3 for the full list of procedure code sources.
memberId	Query string (optional)	The patient’s health plan member ID number.
medicaidId	Query string (optional)	The patient’s Medicaid ID number.
patientSSN	Query string (optional)	The patient’s Social Security Number.
patientLastName	Query string (optional)	The patient’s last name.
patientFirstName	Query string (optional)	The patient’s first name.
patientMiddleName	Query string (optional)	The patient’s middle name.
patientSuffix	Query string (optional)	The patient’s suffix.
patientGender	Query string (optional)	The patient’s gender.
patientBirthDate	Query string (date) (optional)	The patient’s date of birth.
patientState	Query string (optional)	Two-character abbreviation for the patient’s state of residence.
groupNumber	Query string (optional)	The patient’s health plan group number.
subscriberRelationship	Query string (optional)	Specifies the patient’s relationship to the health plan subscriber if the patient is not the subscriber. Values with definitions in parentheses: 18 (Self) 01 (Spouse) 19 (Child) G8 (Other relationship)

Availity stores short-lived, local copies of each coverage request until the time specified by the expirationDate property. If Availity does not have a recent local copy of a particular coverage, it will request one from the health plan. This is an asynchronous process. You can track the current status using the status and statusCode properties. To search your recent coverage requests, you can use the following parameters in addition to the parameters listed above:

Search GET/v1/coverages parameters
Parameter	Type	Definition
status	String (optional)	Search for coverages with a status of In Progress, Request Error, Communication Error, or Complete.
planStatus	String (optional)	Search for coverages with a plan status of Active or Inactive.
q	String (required)	Search for coverages that match free-form search terms.
sortBy	String (optional)	Sort the results by lastUpdateDate, asOfdate, or patientLastName. The default is lastUpdateDate.
sortDirection	String (optional)	Sort the results in asc or desc order. The default is desc.

$ 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: ,;'-.?!&/\\#+=()"
        }
    ]
}

If a coverage reports its statusCode and status properties as 0 and In Progress, respectively, this means Availity is in the process of retrieving the coverage from the health plan. You can either repeat your request or periodically make a GET by {id} request for the coverage until the statusCode and status properties change. In Progress coverages include an etaDate property that reports the time Availity anticipates the refresh will be complete. The status property will then change to one of several values:

Status codes for GET/v1/coverages
Code	Status	Definition
0	In Progress	Availity is in the process of retrieving the coverage from the health plan.
19	Request Error	The health plan has returned one or more validationMessages. (Refer to the validationMessages table.)
R1	Communication Error, Retrying	The health plan did not respond and Availity is retrying the request.
7	Communication Error	The health plan did not respond.
13	Communication Error	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 it is down for maintenance.
4	Complete	The refresh was completed successfully.
3	Complete (Invalid Response)	The refresh was completed successfully, but the health plan's response was partially invalid. Availity still returns all available information from the response, but some values may be missing.

2. GET/v1/coverages/{id}

GET/v1/coverages/{id} parameters
Parameter	Type	Definition
id	Path string (required)	Retrieve full coverage information using the unique response ID from your initial request.

DELETE/v1/coverages/{id} parameters
Parameter	Type	Definition
id	Path string (required)	Delete coverage information using the unique response ID from your initial request.

1. GET/v1/coverages

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"
        }
      ]
    }
  ]
}

$ 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"
      }
    }
  ]
}

$ curl -X GET "https://api.availity.com/availity/v1/coverages?id=00011944990
98175762045868562105833796329766732695450956940743265&id=00011944990981
757620458685621358337963297667326954509569407491523"
    

{
    "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": [...]
        }
    ]
}

$ curl -X DELETE "https://api.availity.com/availity/v1/coverages/0001194499098175
762045868562105833796329766732695450956940743265"

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

Coverages response definitions: Primary result set
Field	Type	Definition
totalCount	Integer	The total number of items available that match the parameters specified.
count	Integer	The number of items returned.
offset	Integer	The zero-based starting index in the collection of the first item to return.
limit	Integer	The maximum number of collection items returned for a single request.
links	Object	Object containing the URL for the request.
coverages	Array	Array providing information about the coverage or coverages you requested. Refer to the coverages table for field definitions.

Coverages response definitions: Fields within coverages
Field	Type	Definition
id	String	The unique response ID from the initial polling request.
customerId	String	The unique number Availity uses to identify an organization.
createdDate	String (date-time)	The time and date the coverage was added to Availity's system.
updatedDate	String (date-time)	The time and date the coverage was last updated in the system.
expirationDate	String (date-time)	The time and date this coverage will expire.
controlNumber	String	An Availity-assigned tracking number for this transaction.
submitterStateCode	String	The submitting customer's configured state code.
status	String	The current status of the coverage request. Refer to the Status codes table for statuses.
statusCode	String	The code for the current status of the coverage request. Refer to the Status codes table for codes.
asOfDate	String (date-time)	The date for which the patient's coverage information is being verified.
toDate	String (date-time)	The end date for the coverage information search.
cardIssueDate	String (date-time)	The patient's health plan member card issue date.
payer	Object	Object providing information about the health plan that returned this coverage information. Refer to the Payer table for field definitions.
requestingProvider	Object	Object providing identifying information about the provider that requested this coverage information, including information sent within the request and additional information sent from the health plan in the response. Refer to the requestingProvider table for field definitions.
patient	Object	Object providing demographic information about the patient, who may be the subscriber or a dependent. Refer to the Patient table for field definitions.
subscriber	Object	Object providing demographic information about the health plan subscriber. Refer to the Subscriber table for field definitions.
plans	Array	Array listing information about all health plans returned for the member. Refer to the Plans table for field definitions.
requestedServiceType	Array	Array listing requested service types. Properties include the service type code and value (description). Refer to the ASC X12 270/271 TR3 for the full list of service type codes.
procedureCode	Array	Array listing requested procedure codes. Refer to the ASC X12 270/271 TR3 for the full list of procedure code sources.
validationMessages	Array	A list of validation messages from the payer. Refer to the validationMessages table for field definitions.

Coverages response definitions: Fields within requestingProvider
Field	Type	Definition
lastName/firstName	String	The requesting provider's last or business name/first name.
type	String	Describes the requesting provider type.
typeCode	String	Code for the requesting provider type. Refer to the X12 270/271 TR3 for the full list of provider type codes.
specialtyCode	String	Code for the requesting provider's specialty. Refer to the X12 270/271TR3 for specialty code sources.
npi	String	The requesting provider's National Provider Identifier (NPI).
taxId	String	The requesting provider's tax ID number.
payerAssignedProviderId	String	The requesting provider's ID assigned by the payer.
ssn	String	The requesting provider's Social Security Number.
submitterId	String	The requesting provider's submitter ID.
placeOfService	String	Description of the place of service.
placeOfServiceCode	String	Code for the place of service. Refer to X12 Code Source 237: Place of Service Codes for Professional Claims.
address	Object	Object providing information about the requesting provider's address. Fields in this object are omitted for brevity.
pin	String	The requesting provider's personal identification number.

Coverages response definitions: Fields within patient
Field	Type	Definition
lastName/firstName /middleName/suffix	String	The patient's last name/first name/middle name/suffix.
birthDate	String (date-time)	The patient's date of birth.
ssn	String	The patient's Social Security Number.
gender	String	The patient's gender.
genderCode	String	Code for the patient's gender. Values with definitions in parentheses: F (female), M (male), U (unknown).
subscriberRelationship	String	Describes the patient's relationship to the subscriber.
subscriberRelationshipCode	String	Code for the patient's relationship to the subscriber. Values with definitions in parentheses: 18 (Self) 01 (Spouse) 19 (Child) G8 (Other relationship)
address	Object	Object providing information about the patient's address. Fields in this object are omitted for brevity.

Coverages response definitions: Fields within subscriber
Field	Type	Definition
memberId	String	The subscriber's health plan member ID number.
medicaidId	String	The subscriber's Medicaid member ID number, if applicable.
lastName/firstName /middleName/suffix	String	The subscriber's last name/first name/middle name/suffix.
birthDate	String (date-time)	The subscriber's date of birth.
gender	String	The subscriber's gender.
genderCode	String	Code for the patient's gender. Values with definitions in parentheses: F (female), M (male), U (unknown).
caseNumber	String	The case number assigned to the subscriber by the information source (e.g., payer, employer, HMO).

Coverages response definitions: Fields within plans
Field	Type	Definition
status	String	The patient's coverage status (e.g., active).
statusCode	String	The code for the coverage status. See the ASC X12 270/271 TR3 for the full list of eligibility and benefit information codes.
identityCardNumber	String	Identifying card number used in addition to the member card number; typically prevalent in the Medicaid environment.
groupNumber	String	The patient's health plan group number.
groupName	String	The patient's health plan group name.
description	String
coverageSummaryAdditionalPayers	Array	Array listing objects for additional payers. Refer to the coverageSummaryAdditionalPayers table for definitions of fields within these objects.
eligibilityStartDate	String (date-time)	Date the patient's eligibility for benefits began/will begin.
eligibilityEndDate	String (date-time)	Date the patient's eligibility for benefits ended/will end.
coverageStartDate	String (date-time)	The date coverage began/will begin.
coverageEndDate	String (date-time)	The date coverage ended/will end.
insuranceType	String	The patient's type of insurance.
insuranceTypeCode	String	Code for the insurance type. Refer to the ASC X12 270/271 TR3 for the full list of insurance type codes.
primaryCareProvider	Object	Object providing information about the patient's primary care provider. Fields (with definitions in parentheses) are as follows: name (primary care provider's name) category (provider's category) categoryCode (code for the provider's category. Refer to the ASC X12 270/271 TR3 for the full list of provider codes.)

Coverages response definitions: Fields within coverageSummaryAdditionalPayers
Field	Type	Definition
name	String	The additional payer's name.
serviceTypeCode	String	Code for the additional payer's service type. See the ASC X12 270/271 TR3 for the full list of service type codes.
insuredMemberId	String	The insured's member ID with the additional payer.
primary	Boolean	Indicates whether this additional payer is the primary payer.
secondary	Boolean	Indicates whether this additional payer is the secondary payer.
tertiary	Boolean	Indicates whether this additional payer is the tertiary payer.
coordinationOfBenefitsBeginDate	String (date)	Date coordination of benefits began/will begin.
coordinationOfBenefitsEndDate	String (date)	Date coordination of benefits ended/will end.
coordinationOfBenefitsDate	String (date)

Coverages response definitions: Fields within validationMessages
Field	Type	Definition
field	String	The field or parameter associated with this error.
code	String	The error code.
errorMessage	String	The message associated with this error.
index	Integer	The array index of the item associated with this error.

Coverages response definitions: Fields within coverage
Field	Type	Definition
id	String	The unique response ID from the initial polling request.
customerId	String	The unique number Availity uses to identify an organization.
controlNumber	String	An Availity-assigned tracking number for this transaction.
status	String	The current status of the coverage request. Refer to the Status codes table for statuses.
statusCode	String	The code for the current status of the coverage request. Refer to the Status codes table for codes.
submitterStatecode	String	The submitting customer's configured state code.
createdDate	String (date-time)	The time and date the coverage was added to Availity's system.
updatedDate	String (date-time)	The time and date the coverage was last updated in the system.
expirationDate	String (date-time)	The time and date this coverage will expire.
asOfDate	String (date-time)	Indicates the date of service for which you want to check coverage information.
toDate	String (date-time)	Provides an end date for your coverage information search period, as required by some health plans.
cardIssueDate	String (date-time)	The issue date of the member's health plan card.
requestedServiceType	Object	Object including fields for the requested service type code and requested service type description. Refer to the ASC X12 270/271 TR3 for the full list of service type codes.
procedureCode	String	Code for the product or service. Refer to the ASC X12 270/271 TR3 for the full list of procedure code sources.
validationMessages	Array	Array listing validation messages from the payer. Refer to the validationMessages table for field definitions.
subscriber	Object	Object providing information about the health plan subscriber. Refer to the coverage.subscriber table for field definitions.
patient	Object	Object providing information about the patient. Refer to the coverage.patient table for field definitions.
payer	Object	Object providing information about the payer. Refer to the coverage.payer table for field definitions.
requestingProvider	Object	Object providing information about the payer. Refer to the coverage.requestingProvider table for field definitions.
plans	Array	Array containing objects with policy plan information. Refer to the coverage.plans table for field definitions.
supplementalInformation	Object	Object containing supplemental information about the coverage. Refer to the supplementalInformation table for field definitions.
reminders	Object	Object containing care reminders pertaining to the coverage. Refer to thereminders table for field definitions.

Coverages response definitions: Fields within coverage.subscriber
Field	Type	Definition
memberId	String	The subscriber's health plan member ID number.
medicaidId	String	The subscriber's Medicaid member ID number, if applicable.
lastName/firstName /middleName/suffix	String	The subscriber's last name/first name/middle name/suffix.
birthDate	String (date-time)	The subscriber's date of birth.
gender	String	The subscriber's gender.
genderCode	String	Code for the patient's gender. Values with definitions in parentheses: F (female), M (male), U (unknown).
ssn	String	The subscriber's Social Security Number.
address	Object	Object providing information about the subscriber's address. Fields in this object are omitted for brevity.
caseNumber	String	The case number assigned to the subscriber by the information source (e.g., payer, employer, HMO).

Coverages response definitions: Fields within coverage.patient
Field	Type	Definition
lastName/firstName /middleName/suffix	String	The patient's last name/first name/middle name/suffix.
patientAccountNumber	String	Number for the patient’s health plan account.
memberId	String	The patient's health plan member ID.
familyUnitNumber	String	Number required when the information source is a Pharmacy Benefit Manager and the patient has a suffix on their member ID number required for use in the NCPDP Telecom Standard.
birthDate	String (date-time)	The patient's date of birth.
deathDate	String (date-time)	The patient's date of death.
ssn	String	The patient's Social Security Number.
gender	String	The patient's gender.
genderCode	String	Code for the patient's gender. Values with definitions in parentheses: F (female), M (male), U (unknown).
subscriberRelationship	String	Describes the patient's relationship to the subscriber.
subscriberRelationshipCode	String	Code for the patient's relationship to the subscriber. Values with definitions in parentheses: 18 (Self) 01 (Spouse) 19 (Child) G8 (Other relationship)
address	Object	Object providing information about the patient's address. Fields in this object are omitted for brevity.
updateYourRecords	Boolean	Indicates whether the patient's demographic or address information needs to be updated.

Coverages response definitions: Fields within coverage.payer
Field	Type	Definition
type	String	The payer's type.
typeCode	String	The code for the payer's type. Refer to the ASC X12 270/271 TR3 for the full list of insurance type codes.
name	String	The payer's name.
payerId	String	The requested payer's Availity-specific identifier.
responsePayerId	String	The ID the payer responded with.
responseName	String	The name the payer responded with.
primary	Boolean	Indicates whether this is the primary payer.
secondary	Boolean	Indicates whether this is the secondary payer.
tertiary	Boolean	Indicates whether this is the tertiary payer.
thirdPartyAdministrator	String	Indicates whether the payer is a third-party administrator.
insuredLastName	String	The insured person's last name.
insuredFirstName	String	The insured person's first name.
insuredMiddleName	String	The insured person's middle name.
insuredMemberId	String	The insured person's health plan member ID.
insuredAddress	Object	Object providing information about the insured person's address. Fields in this object are omitted for brevity.
groupNumber	String	The insured person's group number.
groupName	String	The insured person's group name.
policyNumber	String	The insured person's policy number.
planNumber	String	The insured person's plan number.
planName	String	The insured person's plan name.
planNetworkId	String	The insured person's plan network ID.
memberIdentificationNumber	String	The insured person's member ID number.
familyUnitNumber	String	Number required when the information source is a Pharmacy Benefit Manager and the patient has a suffix on their member ID number required for use in the NCPDP Telecom Standard.
healthInsuranceClaimNumber	String	The health insurance claim number (HICN), a Medicare beneficiary's identification number for paying claims and determining eligibility for services.
medicaidRecipient IdentificationNumber	String	The patient's Medicaid Recipient ID number.
dischargeDate	String (date-time)	Date the patient was discharged.
periodStartDate	String (date-time)	The eligibility period start date.
periodEndDate	String (date-time)	The eligibility period end date.
completionDate	String (date-time)
coordinationOfBenefitsDate	String (date-time)
coordinationOfBenefitsBeginDate	String (date-time)	Date coordination of benefits began/will begin.
coordinationOfBenefitsEndDate	String (date-time)	Date coordination of benefits ended/will end.
coverageStartDate	String (date-time)	Date the patient's coverage started/will start.
coverageEndDate	String (date-time)	Date the patient's coverage ended/will end.
addedDate	String (date-time)
planStartDate	String (date-time)
primaryCareProviderDate	String (date-time)
lastVisitDate	String (date-time)
eligibilityStartDate	String (date-time)	Date the patient's eligibility began.
eligibilityEndDate	String (date-time)	Date the patient's eligibility ended.
benefitBeginDate	String (date-time)	Date benefits began/will begin.
benefitEndDate	String (date-time)	Date benefits ended/will end.
admissionDate	String (date-time)	Date the patient was admitted.
serviceDate	String (date-time)	The date of service.
lastUpdateDate	String (date-time)
statusDate	String (date-time)
insuredContactInformation	Array	Contact information for the insured person. Fields in this array are omitted for brevity.
address
contactInformation	Array	The payer's contact information. Fields in this array are omitted for brevity.
payerNotes	Array	Array containing general disclaimers and messages from the health plan. Refer to the payerNotes table for fields and definitions.
serviceTypeCode	String	Code for the payer's service type. Refer to the ASC X12 270/271 TR3 for the full list of service type codes.

Coverages response definitions: Fields within coverage.requestingProvider
Field	Type	Definition
category	String	Category for the requesting provider.
categoryCode	String	Code for the provider's category. Refer to the ASC X12 270/271 TR3 for the full list of provider codes.
type	String	Describes the requesting provider type.
typeCode	String	Code for the requesting provider type. Refer to the X12 270/271 TR3 for the full list of provider type codes.
role	String	Describes the requesting provider's role related to the eligibility/benefit being inquired about.
roleCode	String	Code for the provider's role. Refer to the ASC X12 270/271 TR3 for the full list of provider codes.
name	String	Business name of the requesting provider.
lastName/firstName/ middleName	String	The requesting provider's last name/first name/middle name.
npi	String	The requesting provider's National Provider Identifier.
taxId	String	The requesting provider's tax ID number.
stateLicenseNumber	String	The requesting provider's state license number.
medicareProviderNumber	String	The requesting provider's Medicare provider number.
medicaidProviderNumber	String	The requesting provider's Medicaid provider number.
facilityId	String	The requesting provider's Facility Identification.
pin	String	The requesting provider's personal identification number.
contractNumber	String	The requesting provider's contract number.
electronicPin	String	The requesting provider's electronic device personal identification number.
providerPlanNetworkId	String	The requesting provider's Provider Plan Network Identification Number.
facilityNetworkId	String	The requesting provider's Facility Network Identification Number.
ssn	String	The requesting provider's Social Security Number.
ein	String	The requesting provider's Employer Identification Number.
etin	String	The requesting provider's Electronic Transmitter Identification Number.
payerId	String	The Availity-specific identifier for the patient's health plan.
pharmacyProcessorNumber	String	The requesting provider's Pharmacy Processor Number.
planId	String	The requesting provider's Centers for Medicare & Medicaid Services Plan ID.
policyNumber	String	The health plan policy number.
memberId	String	The health plan member ID number.
familyUnitNumber	String	Number required when the information source is a Pharmacy Benefit Manager and the patient has a suffix on their member ID number required for use in the NCPDP Telecom Standard.
groupNumber	String	The health plan group number.
referralNumber	String	Number or code that indicates that a referral for services has been approved.
alternateListId	String	Allows the information source to identify a list of drugs and alternative drugs with the associated formulary status for the patient.
coverageListId	String	Allows the information source to identify a list of drugs that have coverage limitations for the associated patient.
healthInsuranceClaimNumber	String	The health insurance claim number (HICN), a Medicare beneficiary's identification number for paying claims and determining eligibility for services.
drugFormularyNumber	String	The drug formulary number.
priorAuthorizationNumber	String	Number that indicates the services on this claim have been authorized.
medicalAssistanceCategoryId	String	The Medical Assistance Category ID number.
planNetworkId	String	The Plan Network Identification number.
planNetworkName	String	The Plan Network name.
medicaidRecipientId	String	The Medicaid recipient ID number.
suhi	String
naicId	String	The requesting provider's National Association of Insurance Commissioners number.
payerAssignedProviderId	String	The requesting provider's payer-assigned provider identification number.
submitterId	String	The requesting provider's submitter ID.
payerAssignedUserId	String	The requesting provider's payer-assigned user ID.
specialty	String	The requesting provider's specialty.
specialtyCode	String	Code for the requesting provider's specialty. Refer to the X12 270/271TR3 for code sources.
placeOfService	String	Identifies the place of service.
placeOfServiceCode	String	Code for the place of service. Refer to X12 Code Source 237: Place of Service Codes for Professional Claims.
dischargeDate	String (date-time)
periodStartDate	String (date-time)
periodEndDate	String (date-time)
completionDate	String (date-time)
coordinationOfBenefitsDate	String (date-time)
coordinationOfBenefitsBegin Date	String (date-time)
coordinationOfBenefitsEnd Date	String (date-time)
coverageStartDate	String (date-time)
coverageEndDate	String (date-time)
addedDate	String (date-time)
planStartDate	String (date-time)
primaryCareProviderDate	String (date-time)
primaryCareProviderStart Date	String (date-time)
primaryCareProviderEnd Date	String (date-time)
lastVisitDate	String (date-time)
eligibilityStartDate	String (date-time)
eligibilityEndDate	String (date-time)
benefitBeginDate	String (date-time)
benefitEndDate	String (date-time)
admissionDate	String (date-time)
serviceDate	String (date-time)
lastUpdateDate	String (date-time)
statusDate	String (date-time)
authorizationRequired	Boolean	Indicates whether the provider is required to obtain authorization to perform this service.
address	Object	Object providing information about the requesting provider's address. Fields in this object are omitted for brevity.
contactInformation	Array	Array providing contact information for the requesting provider. Fields in this array are omitted for brevity.
deliveryInformation	Array	Array listing healthcare service delivery information for the requesting provider. Refer to the requestingprovider.deliveryInformation table for field definitions.
payerNotes	Array	Array listing payer notes about the requesting provider. Refer to the payerNotes table for fields.

Coverages response definitions: Fields within coverage.plans
Field	Type	Definition
status	String	The patient's coverage status (e.g., active).
statusCode	String	The code for the coverage status. See the ASC X12 270/271 TR3 for the full list of eligibility and benefit information codes.
identityCardNumber	String	Identifying card number used in addition to the member card number; typically prevalent in the Medicaid environment.
groupNumber	String	The patient's health plan group number.
groupName	String	The patient's health plan group name.
policyNumber	String	The patient's health plan policy number.
planNumber	String	The patient's health plan number.
planName	String	The patient's health plan name.
planNetworkId	String	The patient's plan network ID.
planNetworkName	String	The patient's plan network name.
contractClassCode		Class of contract code; used in the X12 835 transaction and may be returned if there is sufficient information in the 270 transaction.
contractNumber	String	The provider's contract number.
medicalRecordNumber	String	The medical record identification number.
healthInsuranceClaimNumber	String	The health insurance claim number (HICN), a Medicare beneficiary's identification number for paying claims and determining eligibility for services.
identificationCardSerialNumber	String	The patient's ID card serial number.
identityCardNumber	String	The patient's ID card number.
issueNumber	String	The patient's issue number.
medicaidRecipient IdentificationNumber	String	The patient's Medicaid recipient ID number.
priorIdentificationNumber	String	The patient's prior identifier number.
agencyClaimNumber	String	Claim number used only when the information source is a Property and Casualty payer.
admissionDate	String (date-time)	The patient's admission date.
dischargeDate	String (date-time)	The patient's discharge date.
issueDate	String (date-time)
serviceDate	String (date-time)
coverageStartDate	String (date-time)
coverageEndDate	String (date-time)
planStartDate	String (date-time)
planEndDate	String (date-time)
planEnrollmentDate	String (date-time)
certificationDate	String (date-time)
eligibilityStartDate	String (date-time)	Date the patient's eligibility for benefits began/will begin.
eligibilityEndDate	String (date-time)	Date the patient's eligibility for benefits ended/will end.
policyEffectiveDate	String (date-time)
policyExpirationDate	String (date-time)
effectiveChangeDate	String (date-time)
cobraStartDate	String (date-time)
cobraEndDate	String (date-time)
lastUpdateDate	String (date-time)
addedDate	String (date-time)
premiumPaidToBeginDate	String (date-time)
premiumPaidToEndDate	String (date-time)
periodStartDate	String (date-time)
periodEndDate	String (date-time)
statusDate	String (date-time)
additionalPayers	Array	Array listing information for additional payers. Refer to the coverage.payer table for fields and definitions.
primaryCareProvider	Array	Array listing information for the primary care provider. Refer to the coverage.requestingProvider table for fields and definitions.
contacts	Array	Array listing contact information for the patient. Fields in this array are omitted for brevity.
benefits	Array	Array listing information about benefits. Refer to the coverage.plans.benefits table for fields and definitions.
preexistingConditions	Object	Object providing eligibility/benefit information for preexisting conditions. Refer to the plans.benefits.benefitDetail table for fields and definitions.
costContainment	Object	Object providing information about the total amount the patient will have to pay out of pocket before benefits begin. Typically applies to the Medicaid environment. Refer to the plans.benefits.benefitDetail table for fields and definitions.
limitations	Object	Object providing information about eligibility/ benefit limitations. Refer to the plans.benefits.benefitDetail table for fields and definitions.
benefitDescriptions	Object	Object providing a description of benefits. Refer to the plans.benefits.benefitDetail table for fields and definitions.
coverageBasis	Object	Object providing information about the basis for coverage. Refer to the plans.benefits.benefitDetail table for fields and definitions.
insuranceType	String	The type of insurance.
insuranceTypeCode	String	Code for the insurance type. Refer to the ASC X12 270/271 TR3 for the full list of insurance type codes.
reserve	Object	Refer to the plans.benefits.benefitDetail table for fields and definitions.
payerNotes	Array	List of general payer notes and disclaimers. Refer to the payerNotes table for fields and definitions.

Coverages response definitions: Fields within coverage.plans.benefits
Field	Type	Definition
name	String	The name of the benefit.
type	String	Type of benefit.
source	String	The source of the procedure benefit.
status	String	The status of coverage for this benefit.
statusCode	String	The status code of the coverage for this benefit. See the ASC X12 270/271 TR3 for the full list of eligibility and benefit information codes.
statusDetails	Object	Refer to the plans.benefits.benefitDetail table for fields and definitions.
amounts	Object	Object providing information about amounts involved in this benefit. Refer to the plans.benefits.amounts table for fields and definitions.
limitations	Object	Object providing information about eligibility/ benefit limitations. Refer to the plans.benefits.benefitDetail table for fields and definitions.
benefitDescriptions	Object	Object providing a description of benefits. Refer to the plans.benefits.benefitDetail table for fields and definitions.
nonCovered	Object	Object providing information about non-covered services. Refer to the plans.benefits.benefitDetail table for fields and definitions.
coverageBasis	Object	Object providing information about the basis for coverage. Refer to the plans.benefits.benefitDetail table for fields and definitions.
reserve	Object	Refer to the plans.benefits.benefitDetail table for fields and definitions.
preexistingConditions	Object	Object providing eligibility/benefit information for preexisting conditions. Refer to the plans.benefits.benefitDetail table for fields and definitions.
costContainment	Object	Object providing information about the total amount the patient will have to pay out of pocket before benefits begin. Typically applies to the Medicaid environment. Refer to the plans.benefits.benefitDetail table for fields and definitions.
exclusions	Object	Object providing information about exclusions. Refer to the plans.benefits.benefitDetail table for fields and definitions.
additionalPayers	Array	Array listing information for additional payers. Refer to the coverage.payer table for fields and definitions.
contacts	Array	Array listing additional contacts for this benefit. Refer to the coverage.requestingProvider table for fields and definitions.
payerNotes		List of general payer notes and disclaimers. Refer to the payerNotes table for fields and definitions.

Coverages response definitions: Fields within plans.benefits.benefitDetail
Field	Type	Definition
inNetwork	Array	Array listing information about benefits that apply to in-network providers. Refer to the networkBenefit table for fields and definitions.
outOfNetwork	Array	Array listing information about benefits that apply to out-of-network providers. Refer to the networkBenefit table for fields and definitions.
notApplicableNetwork	Array	Array listing information about benefits that apply regardless of network. Refer to the networkBenefit table for fields and definitions.
noNetwork	Array	Array listing information about benefits that are not specific to a network. Refer to the networkBenefit table for fields and definitions.

Coverages response definitions: Fields within plans.benefits.benefitDetail.amounts
Field	Type	Definition
coPayment	Object	Object providing information about copayment amounts. Refer to the plans.benefits.benefitDetail table for fields and definitions.
outOfPocket	Object	Object providing information about out-of-pocket amounts. Refer to the plans.benefits.benefitDetail table for fields and definitions.
deductibles	Object	Object providing information about deductible amounts. Refer to the plans.benefits.benefitDetail table for fields and definitions.
coInsurance	Object	Object providing information about coinsurance amounts. Refer to the plans.benefits.benefitDetail table for fields and definitions.

Coverages response definitions: Fields within plans.benefits.benefitDetail.networkBenefit
Field	Type	Definition
status	String
statusCode	String	The code for the coverage status. See the ASC X12 270/271 TR3 for the full list of eligibility and benefit information codes.
insuranceType	String	The patient's type of insurance.
insuranceTypeCode	String	Code for the insurance type. Refer to the ASC X12 270/271 TR3 for the full list of insurance type codes.
amount	String
units	String
amountTimePeriod	String	The time period this benefit applies to.
amountTimePeriodCode	String
remaining	String	The remaining amount.
remainingTimePeriod	String	The time period that the remaining benefit applies to.
remainingTimePeriodCode	String
total	String	Total amount.
totalTimePeriod	String
totalTimePeriodCode	String
level	String
levelCode	String
quantity	String
quantityQualifier	String
quantityQualifierCode	String
authorizationRequired	Boolean	Indicates whether the provider is required to obtain authorization to perform this service.
authorizationRequiredUnknown	Boolean	Indicates if it is unknown whether the provider is required to obtain authorization.
placeOfService	String	Description of the place of service.
placeOfServiceCode	String	Code for the place of service. Refer to X12 Code Source 237: Place of Service Codes for Professional Claims.
description	String
planNumber	String	The plan number.
planName	String	The plan name.
policyNumber	String	The plan network ID.
memberIdentificationNumber	String	The member ID number.
familyUnitNumber	String	Number required when the information source is a Pharmacy Benefit Manager and the patient has a suffix on their member ID number required for use in the NCPDP Telecom Standard.
groupNumber	String	The patient's health plan group number.
groupName	String	The patient's health plan group name.
referralNumber	String	Number or code that indicates that a referral for services has been approved.
healthInsuranceClaimNumber	String	The health insurance claim number (HICN), a Medicare beneficiary's identification number for paying claims and determining eligibility for services.
priorAuthorizationNumber	String	Number that indicates the services on this claim have been authorized.
insurancePolicyNumber	String	The health insurance policy number.
planNetworkId	String	The insured person's plan network ID.
planNetworkName	String	The insured person's member ID number.
medicaidRecipient IdentificationNumber	String	The patient's Medicaid Recipient ID number.
dischargeDate	String
periodStartDate	String
periodEndDate	String
completionDate	String
coordinationOfBenefitsDate	String
coordinationOfBenefits BeginDate	String
coordinationOfBenefitsEndDate	String
coverageStartDate	String
coverageEndDate	String
addedDate	String
planStartDate	String
primaryCareProviderDate	String
lastVisitDate	String
eligibilityStartDate	String
eligibilityEndDate	String
benefitBeginDate	String
benefitEndDate	String
admissionDate	String
serviceDate	String
lastUpdateDate	String
statusDate	String
contacts	Array	Array listing contact information for this benefit. Fields in this array are omitted for brevity.
payerNotes	Array	Array containing general disclaimers and messages from the health plan. Refer to the payerNotes table for fields and definitions.
deliveryInformation	Array	Array containing service delivery information. Refer to the deliveryInformation table for fields and definitions.

Coverages response definitions: Fields within coverage.supplementalInformation
Field	Type	Definition
professionalPatientCost Estimator	Boolean	Indicates whether the Professional Patient Cost Estimator is available.
institutionalPatientCost Estimator	Boolean	Indicates whether the Institutional Patient Cost Estimator is available.
patientCareSummary	Boolean	Indicates whether the patient care summary is available.
patientCareSummaryReason	String	Indicates the reason for the patient care summary availability.
patientCareSummaryReasonCode	String	Code for the reason for the patient care summary availability.
assessmentCarePlan	Boolean	Indicates whether an assessment and care plan are available.
thirdPartySystemId		Third party system ID for supplemental information.
routingCode		Routing code for supplemental information.
outOfArea	Boolean	Flag used by certain payers to indicate out of area.
clickToTalkPhoneNumber	String
clickToTalkKey
localMemberId	String	Local member ID for third-party clinical exchanges.
pceMemberLocatorKey	String	Local member key for patient cost estimator for third-party clinical exchanges.
pceHostIndicator	Boolean	Host plan indicator for patient cost estimator for third-party clinical exchanges.
referralShortFormIndicator	Boolean	Referral short form indicator.
viewReferralAuthIndicator	Boolean	View all auths and referrals indicator.
csnpIndicator	Boolean	Indicates whether a C-SNP form is available.
requestLtssccAmount	Boolean	Indicates whether to initiate a request to LTSSCC.
pregnant	Boolean	Indicates whether the Patient Assessment (Maternity) form exists.
pharmacyRestrictions	Object	Object containing information about pharmacy restrictions. Includes fields for address and contact information, effective date, and termination date.
erReferralCompleted	Boolean	Indicates whether the ER Referral Questionnaire was completed.

Coverages response definitions: Fields within coverage.reminders
Field	Type	Definition
titles	Object	Object containing clinical message titles.
messages	Array	Array listing objects containing clinical message content.
inference	String	Clinical inference.

Coverages response definitions: Fields within payerNotes
Field	Type	Definition
type	String	Describes the type of note.
typeCode	String	Code for the type of note.
message	String	The content of the note from the payer.

	Path	Function
1	POST/v2/service-reviews	Create service reviews asynchronously. To submit a transaction, make a valid request and Availity responds with a location header containing a URL you can query for your result.
2	GET/v2/service-reviews	Search for service reviews in the health plan's system. This endpoint queries the health plan's system asynchronously. To submit a transaction, make a valid request and Availity responds with a location header containing a URL you can query for your result. This method can be used to check the status of a service review and is a prerequisit to performing and update or delete.
3	GET/v2/service-reviews/{id}	Retrieve a specific service review. Replace {id} with the response ID from your initial request.
4	PUT/v2/service-reviews	Update service reviews asynchronously. Only a service review with updatable=true can be updated. Once you make a valid request, Availity will respond with a location header containing a URL you can query for your result while Availity asynchronously sends an updated copy of the service review to the health plan. Note: The updatableFields array will list which fields the payer allows the client to update.
5	DELETE/v2/service-reviews/{id}	Void an existing service review asynchronously. Only a service review with deletable=true can be voided. Once you make a valid request, Availity responds with a location header containing a URL you can query for your result while asynchronously sending a void request to the health plan. Replace {id} with the response ID from your initial request.

To test the demo version of this API, send the (X-Api-Mock-Scenario-ID) header with the appropriate response scenario ID, as listed in the following table. For POST methods, send an empty JSON body: {}.

Service Reviews demo response scenarios
Response scenario ID	Method	Status code	Definition
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 can retry your request 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 an error in 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 and Availity is retrying the request.
SRI-GetAccepted-i	GET	202	Availity is processing your request.
SRI-GetComplete-i	GET	200	Availity has successfully retrieved the member's service review information from the health plan.
SRI-GetInProgress-i	GET	202	Availity is processing your request.
SRI-GetPayerError-i	GET	400	The health plan indicated an error in 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 can retry your request later.
SRI-GetRetrying-i	GET – use {id} 12345678	202	The health plan did not respond and Availity is retrying the request.
SRI-GetRequestError-i	GET	400	The health plan indicated an error in the request. The resource should have a list of validationMessages. Correct and resubmit the request.

$ curl -i -X GET https://api.availity.com/availity/v1/configurations?
type=service-reviews&subtypeId=HS&payerId=BCBSF

1. POST /v2/service-reviews

Parameter/Request body	Type	Definition
serviceReview	Body object (optional)	Represents the details of the service review you are creating. Refer to the request body for possible fields. Refer to Response definitions for field definitions.
Content-Type	Header string (optional)	Allows you to specify application/json or application/xml
Accept	Header string (optional)	Allows you to specify application/json or application/xml

{
    "type": "object",
    "properties": {
        "id": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "customerId": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "controlNumber": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "userId": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "shortFormIndicator": {
            "type": "boolean",
            "$ref": "#/definitions/Primaryfields"
        },
        "updatable": {
            "type": "boolean",
            "$ref": "#/definitions/Primaryfields"
        },
        "deletable": {
            "type": "boolean",
            "$ref": "#/definitions/Primaryfields"
        },
        "updatableFields": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "status": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "statusCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "statusReasons": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "createdDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "updatedDate": {
            "type": "string",
           "$ref": "#/definitions/Primaryfields"
        },
        "expirationDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "validationMessages": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "providerNotes": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "payerNotes": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "payer": {
            "$ref": "#/definitions/Primaryfields"
        },
        "requestingProvider": {
            "$ref": "#/definitions/Primaryfields"
        },
        "subscriber": {
            "$ref": "#/definitions/Primaryfields"
        },
        "patient": {
            "$ref": "#/definitions/Primaryfields"
        },
        "diagnoses": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "certificationIssueDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "certificationEffectiveDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "certificationExpirationDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "certificationNumber": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "referenceNumber": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "traceNumbers": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "requestType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "requestTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "serviceType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "serviceTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "additionalServiceTypes": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "placeOfService": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "placeOfServiceCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "serviceLevel": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "serviceLevelCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "fromDate": {
            "type": "string",
            "format": "date",
            "$ref": "#/definitions/Primaryfields"
        },
        "toDate": {
            "type": "string",
            "format": "date",
            "$ref": "#/definitions/Primaryfields"
        },
        "quantity": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "quantityType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "quantityTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "admissionType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "admissionTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "admissionSource": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "admissionSourceCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "nursingHomeResidentialStatus": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "nursingHomeResidentialStatusCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "homeHealthStartDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "homeHealthCertificationPeriodStartDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "homeHealthCertificationPeriodEndDate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "transportType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "transportTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "transportDistance": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "transportPurpose": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "chiropracticTreatmentCount": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "beginningSubluxationLevel": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "beginningSubluxationLevelCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "endingSubluxationLevel": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "endingSubluxationLevelCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "spinalCondition": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "spinalConditionCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "spinalConditionDescription": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenEquipmentType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenEquipmentTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenFlowRate": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenDailyUseCount": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenUsePeriodHourCount": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenOrderText": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenDeliverySystemType": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "oxygenDeliverySystemTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "transportLocations": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "procedures": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "renderingProviders": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        },
        "supplementalInformation": {
            "$ref": "#/definitions/Primaryfields"
        }
    }
}

Parameter	Type	Definition
payer.id	Query string (optional)	The Availity-specific identifier for the patient's health plan.
requestingProvider.specialtyCode	Query string (optional)	The requesting provider's specialty code. Refer to X12 External Code Source 682: Provider Taxonomy Codes.
requestingProvider.lastName	Query string (optional)	The requesting provider's last or business name.
requestingProvider.firstName	Query string (optional)	The requesting provider's first name.
requestingProvider.middleName	Query string (optional)	The requesting provider's middle name.
requestingProvider.suffix	Query string (optional)	The requesting provider's suffix.
requestingProvider.npi	Query string (optional)	The requesting provider's National Provider Identifier (NPI).
requestingProvider.taxId	Query string (optional)	The requesting provider's tax ID number.
requestingProvider.payer AssignedProviderId	Query string (optional)	The requesting provider's payer-assigned provider ID.
requestingProvider.submitterId	Query string (optional)	The requesting provider's health plan-specific submitter ID.
requestingProvider.addressLine1	Query string (optional)	First line of the requesting provider's address.
requestingProvider.addressLine2	Query string (optional)	Second line of the requesting provider's address.
requestingProvider.city	Query string (optional)	The requesting provider's city.
requestingProvider.stateCode	Query string (optional)	Two-character abbreviation for the requesting provider's state.
requestingProvider.zipCode	Query string (optional)	The requesting provider's ZIP code.
requestingProvider.contactName	Query string (optional)	Name for the requesting provider's contact person.
requestingProvider.phone	Query string (optional)	The requesting provider's phone number/extension/fax number.
requestingProvider.extension	Query string (optional)	The requesting provider's phone extension.
requestingProvider.fax	Query string (optional)	The requesting provider's fax number.
subscriber.memberId	Query string (optional)	The health plan subscriber's member ID number.
subscriber.firstName	Query string (optional)	The health plan subcriber's first name.
subscriber.lastName	Query string (optional)	The health plan subcriber's last name.
subscriber.middleName	Query string (optional)	The health plan subcriber's middle name.
subscriber.suffix	Query string (optional)	The health plan subcriber's suffix.
patient.lastName	Query string (optional)	The patient's last name.
patient.firstName	Query string (optional)	The patient's first name.
patient.middleName	Query string (optional)	The patient's middle name.
patient.suffix	Query string (optional)	The patient's suffix.
patient.birthDate	Query string (date) (optional)	The patient's birth date.
patient.subscriberRelationshipCode	Query string (optional)	Code representing the patient's relationship to the subscriber. Values with definitions in parentheses: 18 (Self) 01 (Spouse) 19 (Child) G8 (Other relationship)
requestTypeCode	Query string (optional)	The code for the request type. Possible values: HS (Health Services Review/outpatient), AR (Admission Review/inpatient), and SC (Specialty Care Review/referral).
fromDate	Query string (date) (optional)	The service beginning date.
toDate	Query string (date) (optional)	The service end date.
certificationIssueDate	Query string (optional)	The date the authorization certification was issued.
certificationNumber	Query string (optional)	Number assigned by the health plan once an authorization is certified.
referenceNumber	Query string (optional)	Number assigned by the health plan for a submitted authorization while it is being reviewed (prior to certification). Typically, the terms "reference number," "case number," and "authorization number" are synonymous.
statusCode	Query string (optional)	Code for the status of the authorization or referral. Refer to the status and statusCodes table for values and definitions.
sessionId	Query string (optional)	Identifier included in a 200, 404, and 504 response. Valid for 24 hours.

3. GET /v2/service-reviews/{id}

Parameter	Type	Definition
id	Path string (required)	The unique response ID from your initial request.
Accept	Header string (optional)	Allows you to specify application/json or application/xml

4. PUT /v2/service-reviews

Parameter/Request body	Type	Definition
serviceReview	Body object (optional)	Represents the service review you are updating. Refer to the request body for fields and definitions.
Content-Type	Header string (optional)	Allows you to specify application/json or application/xml
Accept	Header string (optional)	Allows you to specify application/json or application/xml

5. DELETE /v2/service-reviews/{id}

Parameter	Type	Definition
id	Path string (required)	The unique response ID from your initial request.
Accept	Header string (optional)	Allows you to specify application/json or application/xml

curl -X POST "https://api.availity.com/availity/v2/service-reviews" -d { "payer": { "name": "FLORIDA BLUE", "id": "BCBSF" }, 
"requestingProvider": { "lastName": "RP Surgery Center", "npi": "1111111112", "submitterId": "G12345", "specialtyCode": "207T00000X"
, "addressLine1": "321 Main St", "city": "JACKSONVILLE", "state": "Florida", "stateCode": "FL", "zipCode": "322231234", "contactName":
 "John Doe", "phone": "9043334444" }, "subscriber": { "firstName": "Jane", "middleName": "J", "lastName": "Smith", "suffix": "JR", 
"memberId": "TEST1", "addressLine1": "123 MAIN ST", "addressLine2": "APT 3", "city": "JACKSONVILLE", "state": "Florida", "stateCode": 
"FL", "zipCode": "123123331" }, "patient": { "firstName": "Jane", "middleName": "J", "lastName": "Smith", "suffix": "JR", 
"subscriberRelationship": "Self", "subscriberRelationshipCode": "18", "birthDate": "2009-09-09T05:00:00.000+0000", "gender": "Female",
 "genderCode": "F", "addressLine1": "123 MAIN ST", "addressLine2": "APT 3", "city": "JACKSONVILLE", "state": "Florida", "stateCode": 
"FL", "zipCode": "123123331" }, "diagnoses": [ { "qualifier": "International Classification of Diseases Clinical Modification (ICD-10-CM)
 Principal Diagnosis", "qualifierCode": "BF", "value": "Medical Diagnosis", "code": "0011", "date": "2015-01-01T05:00:00.000+0000" } ], 
"requestTypeCode": "AR", "serviceTypeCode": "1", "placeOfServiceCode": "21", "fromDate": "2015-01-01T05:00:00.000+0000", 
"admissionTypeCode": "1", "admissionSourceCode": "1", "renderingProviders": [ { "lastName": "smith", "firstName": "bobby", 
"npi": "1111111112", "specialtyCode": "282N00000X", "roleCode": "SJ", "addressLine1": "321 Main St", "city": "Jacksonville", 
"stateCode": "FL", "zipCode": "322561234" } ] } 

{
  "links": {
    "self": {
      "href": "https://api.availity.com/availity/v2/service-reviews/0001234476904234805
       043040461830325519306571042495809029976148661"
    }
  },
  "id": "0001234476904234805043040461830325519306571042495809029976148661",
  "customerId": "1234",
  "status": "Building Request",
  "statusCode": "BR",
  "createdDate": "2015-02-24T18:51:39.000+0000",
  "updatedDate": "2015-02-24T18:51:39.000+0000",
  "expirationDate": "2015-02-25T18:51:39.000+0000",
  "validationMessages": [
    {
      "field": "renderingProviders",
      "errorMessage": "Please enter at least one Service Provider and one Facility."
    }
  ],
  "payer": {
    "name": "FLORIDA BLUE",
    "id": "BCBSF"
  },
  "requestingProvider": {
    "lastName": "RP Surgery Center",
    "npi": "1111111112",
    "submitterId": "G12345",
    "specialtyCode": "207T00000X",
    "addressLine1": "321 Main St",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "322231234",
    "contactName": "John Doe",
    "phone": "9043334444"
  },
  "subscriber": {
    "firstName": "Jane",
    "middleName": "J",
    "lastName": "Smith",
    "suffix": "JR",
    "memberId": "TEST1",
    "addressLine1": "123 MAIN ST",
    "addressLine2": "APT 3",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "123123331"
  },
  "patient": {
    "firstName": "Jane",
    "middleName": "J",
    "lastName": "Smith",
    "suffix": "JR",
    "subscriberRelationship": "Self",
    "subscriberRelationshipCode": "18",
    "birthDate": "2009-09-09T05:00:00.000+0000",
    "gender": "Female",
    "genderCode": "F",
    "addressLine1": "123 MAIN ST",
    "addressLine2": "APT 3",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "123123331"
  },
  "diagnoses": [
    {
      "qualifier": "International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis",
      "qualifierCode": "BF",
      "value": "Medical Diagnosis",
      "code": "0011",
      "date": "2015-01-01T05:00:00.000+0000"
    }
  ],
  "requestTypeCode": "AR",
  "serviceTypeCode": "1",
  "placeOfServiceCode": "21",
  "fromDate": "2015-01-01T05:00:00.000+0000",
  "admissionTypeCode": "1",
  "admissionSourceCode": "1",
  "renderingProviders": [
    {
      "lastName": "smith",
      "firstName": "bobby",
      "npi": "1111111112",
      "specialtyCode": "282N00000X",
      "roleCode": "SJ",
      "addressLine1": "321 Main St",
      "city": "Jacksonville",
      "stateCode": "FL",
      "zipCode": "322561234"
    }
  ]
}' 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.

curl -X GET
      "https://api.availity.com/availity/v2/service-reviews?requestTypeCode=AR&
requestingProviderLastName=Procorp&requestingProviderNPI=1234567893&submitterId=G12345
&requestingProviderSpecialtyCode=207X00000X&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"
    

$ curl -i -X GET -i https://api.availity.com/availity/v2/service-reviews?request
TypeCode=AR&requestingProviderLastName=SLICE N DICE DISCOUNT SURGERY&requestingProvider
AddressLine1=123Street&requestingProviderCity=Jacksonville&requestingProviderState=FL&
requestingProviderZipCode=123451234&requestingProviderContactName=John&requestingProvider
Phone=1112223333&memberId=TEST1&patientLastName=Doe&patientFirstName=John&patientBirth
Date=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.

$ 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&requestingProvider
AddressLine1=123Street&requestingProviderCity=Jacksonville&requestingProviderState=FL&
requestingProviderZipCode=123451234&requestingProviderContactName=John&requestingProvider
Phone=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"
    }]
}

curl -X GET "https://api.availity.com/availity/v2/service-reviews/0001233411014786160466715575
       7587374114129045756512963141509096868"
    

{
  "links": {
    "self": {
      "href": "https://api.availity.com/availity/v2/service-reviews/000123341101478616046
       67155757587374114129045756512963141509096868"
    }
  },
  "id": "00012334110147861604667155757587374114129045756512963141509096868",
  "customerId": "1234",
  "controlNumber": "31722",
  "status": "Certified in Total",
  "statusCode": "A1",
  "createdDate": "2015-02-24T19:28:44.000+0000",
  "updatedDate": "2015-02-24T19:28:48.000+0000",
  "expirationDate": "2015-02-25T19:28:44.000+0000",
  "serviceReviewEffectiveDate": "2014-11-28T05:00:00.000+0000",
  "serviceReviewExpireDate": "2014-11-27T05:00:00.000+0000",
  "serviceReviewNumber": "123306685",
  "payer": {
    "name": "FLORIDA BLUE",
    "id": "BCBSF"
  },
  "requestingProvider": {
    "lastName": "John Doe Hospital",
    "npi": "1233459975",
    "submitterId": "H1123",
    "specialty": "General Hospital",
    "specialtyCode": "282N00000X",
    "addressLine1": "123 MAIN ST",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "322231234",
    "contactName": "John Doe",
    "phone": "7275271234",
    "fax": "7273695123"
  },
  "subscriber": {
    "firstName": "JAMIE",
    "lastName": "SMITH",
    "memberId": "XJBH1234567890",
    "addressLine1": "123 MAIN ST",
    "addressLine2": "APT 3",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "123123331"
  },
  "patient": {
    "firstName": "ARINA",
    "lastName": "JOHNSON",
    "subscriberRelationship": "Spouse",
    "subscriberRelationshipCode": "01",
    "birthDate": "1988-08-08T05:00:00.000+0000",
    "gender": "Female",
    "genderCode": "F",
    "addressLine1": "123 MAIN ST",
    "addressLine2": "APT 3",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "123451112"
  },
  "diagnoses": [
    {
      "qualifier": "International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis",
      "qualifierCode": "BF",
      "value": "Cholera d/t vib el tor",
      "code": "0011",
      "date": "2014-11-17T05:00:00.000+0000"
    }
  ],
  "requestType": "Admission Review",
  "requestTypeCode": "AR",
  "serviceType": "Maternity",
  "serviceTypeCode": "69",
  "placeOfService": "Inpatient Hospital",
  "placeOfServiceCode": "21",
  "fromDate": "2014-11-18T05:00:00.000+0000",
  "quantity": "3",
  "quantityType": "Days",
  "quantityTypeCode": "DY",
  "admissionType": "Emergency",
  "admissionTypeCode": "1",
  "admissionSource": "Transfer from Hospital",
  "admissionSourceCode": "4",
  "nursingHomeResidentialStatus": "Newly Admitted",
  "nursingHomeResidentialStatusCode": "2",
  "procedures": [
    {
      "qualifier": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
      "qualifierCode": "HC",
      "value": "OBSTETRICAL CARE",
      "code": "59409",
      "description": "PROCEDURE DATES- 20141118",
      "fromDate": "2015-01-02T05:00:00.000+0000",
      "toDate": "2015-01-03T05:00:00.000+0000"
    }
  ],
  "renderingProviders": [
    {
      "lastName": "ABC HOSPITAL",
      "npi": "1477123123",
      "specialty": "General Hospital",
      "specialtyCode": "282N00000X",
      "role": "Service Provider",
      "roleCode": "SJ",
      "addressLine1": "200 MAIN ST",
      "city": "ORLANDO",
      "state": "Florida",
      "stateCode": "FL",
      "zipCode": "33881",
      "phone": "8632931123"
    },
    {
      "role": "Attending Physician",
      "roleCode": "71",
      "lastName": "MUNA",
      "firstName": "TELT",
      "middleName": "D",
      "npi": "1234567893",
      "specialty": "Obstetrics & Gynecology",
      "specialtyCode": "207V00000X",
      "addressLine1": "123 CENTRAL AVE",
      "city": "ORLANDO",
      "state": "Florida",
      "stateCode": "FL",
      "zipCode": "33880",
      "phone": "8632123123",
      "fax": "8632123123"
    }
  ]
}

curl -X PUT "https://api.availity.com/availity/v2/service-reviews" -d { "renderingProviders": [ { "lastName": 
"smith", "firstName": "bobby", "npi": "1111111112", "specialtyCode": "282N00000X", "roleCode": "SJ", "addressLine1": 
"123 Main St", "city": "Jacksonville", "stateCode": "FL", "zipCode": "322561234" }, { "lastName": "Surgery Center", 
"npi": "1234567893", "specialtyCode": "282N00000X", "roleCode": "FA", "addressLine1": "123 Main St", "addressLine2": 
"123 Second St", "city": "Jacksonville", "stateCode": "FL", "zipCode": "322581234" } ] } 

{
  "links": {
    "self": {
      "href": "https://api.availity.com/availity/v2/service-reviews/00012344769042348050430
       40461830325519306571042495809029976148661"
    }
  },
  "id": "0001234476904234805043040461830325519306571042495809029976148661",
  "customerId": "1234",
  "status": "In Progress",
  "statusCode": "0",
  "createdDate": "2015-02-24T18:24:25.000+0000",
  "updatedDate": "2015-02-24T18:24:25.000+0000",
  "expirationDate": "2015-02-25T18:24:25.000+0000",
  "validationMessages": [],
  "payer": {
    "name": "FLORIDA BLUE",
    "id": "BCBSF"
  },
  "requestingProvider": {
    "lastName": "RP Surgery Center",
    "npi": "1111111112",
    "submitterId": "G12345",
    "specialtyCode": "282N00000X",
    "addressLine1": "123 MAIN ST",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "322231234",
    "contactName": "John Doe",
    "phone": "9043334444"
  },
  "subscriber": {
    "firstName": "Jane",
    "middleName": "J",
    "lastName": "Smith",
    "suffix": "JR",
    "memberId": "TEST1",
    "addressLine1": "123 MAIN ST",
    "addressLine2": "APT 3",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "123123331"
  },
  "patient": {
    "firstName": "Jane",
    "middleName": "J",
    "lastName": "Smith",
    "suffix": "JR",
    "subscriberRelationship": "Self",
    "subscriberRelationshipCode": "18",
    "birthDate": "2009-09-08T05:00:00.000+0000",
    "gender": "Female",
    "genderCode": "F",
    "addressLine1": "123 MAIN ST",
    "addressLine2": "APT 3",
    "city": "JACKSONVILLE",
    "state": "Florida",
    "stateCode": "FL",
    "zipCode": "123123331"
  },
  "diagnoses": [
    {
      "qualifier": "International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis",
      "qualifierCode": "BF",
      "value": "Medical Diagnosis",
      "code": "0011",
      "date": "2015-01-01T05:00:00.000+0000"
    }
  ],
  "requestTypeCode": "AR",
  "serviceTypeCode": "1",
  "placeOfServiceCode": "21",
  "fromDate": "2015-01-01T05:00:00.000+0000",
  "toDate": "2015-02-02T05:00:00.000+0000",
  "quantity": "2",
  "quantityTypeCode": "DY",
  "admissionTypeCode": "1",
  "admissionSourceCode": "1",
  "nursingHomeResidentialStatusCode": "2",
  "renderingProviders": [
    {
      "lastName": "smith",
      "firstName": "bobby",
      "npi": "1111111112",
      "specialtyCode": "282N00000X",
      "roleCode": "SJ",
      "addressLine1": "123 Main St",
      "city": "Jacksonville",
      "stateCode": "FL",
      "zipCode": "322561234"
    },
    {
      "lastName": "Surgery Center",
      "npi": "1234567893",
      "specialtyCode": "282N00000X",
      "roleCode": "FA",
      "addressLine1": "123 Main St",
      "addressLine2": "123 Second St",
      "city": "Jacksonville",
      "stateCode": "FL",
      "zipCode": "322581234"
    }
  ]
}

curl -X DELETE "https://api.availity.com/availity/v2/service-reviews/
-11923818311"

$ 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.

Service Reviews response definitions: Primary result set
Field	Type	Definition
id	String	The unique response ID from your initial request.
customerId	String	The Availity customer ID of the organization that submitted the authorization or referral. Availity may ask for this number during support calls.
userId	String	The user ID of the organization that submitted this service review.
status	String	Describes the current status of the service review. Refer to the status and statusCodes table for status and status code definitions.
statusCode	String	The code for the current status of the authorization or referral. Refer to the status and statusCodes table for status and status code definitions.
statusReasons	Object array	Provides information about the reason(s) the health plan has given for the current status of the authorization or referral. Refer to the statusReasons table for field definitions.
createdDate	Timestamp	The date and time Availity created the item in the system.
updatedDate	Timestamp	The date and time the item was last updated.
expirationDate	Timestamp	The date and time the item will be removed from Availity's system.
controlNumber	String	The ID number of the last transaction associated with this service review. The health plan may ask for this number during support calls.
shortFormIndicator	Boolean	Used to set the transaction type code. Whether TRUE or FALSE, this indicator sets the transaction type code to 25 for admission reviews and 26 for health service reviews. For specialty care review, the transaction type code is set as follows: TRUE: 429 FALSE: 24
updatable	Boolean	Indicates whether the service review can be updated.
updatableFields	String array	Indicates the fields the health plan allows to be updated.
deletable	Boolean	Indicates whether the service review can be deleted.
validationMessages	Object array	Provides information about problems with the service review. Errors encountered during validation at Availity have a field and possibly an index, while errors returned by the health plan have a code. Refer to the validationMessages table for field definitions.
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 took place.
certificationExpirationDate	Date	The date on which the health plan's authorization expires.
certificationNumber	String	The health plan's authorization number for claims.
referenceNumber	String	The health plan's reference number assigned to pended or otherwise incomplete service reviews.
traceNumbers	String array	The array of trace numbers the health plan has assigned to the service review.
requestType	String	Describes the type of request: inpatient service authorization/referral, outpatient service authorization/referral, or referral.
requestTypeCode	String	The code for the request type. Values: HS (Health Services Review/outpatient), AR (Admission Review/inpatient), and SC (Specialty Care Review/referral).
payer	Object	Object providing information about the patient's health plan. Refer to the Payer table for field definitions.
payerNotes	Object array	Provides information about the array of notes the health plan added to the service review. Text is included in the payerNotes.message field.
providerNotes	Array	Provides information about the array of notes the provider added to the service review.
requestingProvider	Object	Object providing information about the provider who requested authorization to perform the service or referral. Refer to the requestingProvider table for field definitions.
subscriber	Object	Object providing information about the health plan subscriber. Refer to the Subscriber table for field definitions.
patient	Object	Object providing information about the patient who received/will receive the service or referral. Refer to the Patient table for field definitions.
diagnoses	Object array	Array providing information about the patient's diagnosis/es related to the service or referral. Refer to the Diagnoses table for field definitions.
serviceType	String	Describes the type of service to be rendered.
serviceTypeCode	String	Code indicating the service type. Refer to the ASC X12 278 TR3 for the full list of service type codes.
additionalServiceTypes	Array	Describes additional types of services to be rendered.
placeOfService	String	Describes the place the service was rendered. Refer to X12 External Code Source 237: Place of Service Codes for Professional Claims (professional) or External Code Source 236: Uniform Billing Claim Form Bill Type (institutional).
placeOfServiceCode	String	The code for the place the service was or will be rendered. Refer to X12 External Code Source 237: Place of Service Codes for Professional Claims (professional) or External Code Source 236: Uniform Billing Claim Form Bill Type (institutional).
serviceLevel	String	Describes the level of service rendered.
serviceLevelCode	String	The code for the service level.
fromDate	Date	The service or admission starting date.
toDate	Date	The service end date or discharge date.
quantity	String	The number of units associated with the service.
quantityType	String	Describes the type of units.
quantityTypeCode	String	The code for the type of units.
admissionType	String	Describes the type of admission listed in an inpatient authorization request.
admissionTypeCode	String	The code for the admission type. Refer to X12 External Code Source 231: Admission Type Code.
admissionSource	String	Describes the source of the admission listed in an inpatient authorization request.
admissionSourceCode	String	The code for the admission source. Refer to X12 External Code Source 230: Admission Source Code.
nursingHomeResidentialStatus	String	Indicates whether the patient is a nursing home resident.
nursingHomeResidential StatusCode	String	The code for the patient's nursing home residential status.
homeHealthStartDate	Date	The starting date of the patient's home health services.
homeHealthCertificationPeriod StartDate	Date	The starting date of the period for which home health services were certified.
homeHealthCertificationPeriod EndDate	Date	The end date of the period for which home health services were authorized.
transportType	String	The type of transport used in a medically-related transport outpatient authorization request.
transportTypeCode	String	The code for the transport type.
transportDistance	String	The distance the patient was transported on a medically related transport outpatient authorization request.
transportPurpose	String	The purpose of the patient transport.
transportLocations	Object array	An array providing information on the locations associated with a medically related transport outpatient authorization request. Refer to the transportLocations table for field definitions.
chiropracticTreatmentCount	String	Number of the chiropractic treatment if it is one in a series.
beginningSubluxationLevel	String	Level of sublaxation at the beginning of chiropractic treatment.
beginningSubluxationLevelCode	String	Code for the level of sublaxation at the beginning of chiropractic treatment. Refer to the ASC X12 278 TR3 (Health Care Services Review and Response) for the full list of subluxation level codes.
endingSubluxationLevel	String	Code for the level of subluxation at the end of chiropractic treatment. Refer to the ASC X12 278 TR3 for the full list of subluxation level codes.
spinalCondition	String	Description of the spinal condition. Mapped to CR208 in the ASC X12 278 TR3.
spinalConditionCode	String	Code for the spinal condition. Equivalent to Nature of Condition code (CR208) in the ASC X12 278 TR3.
spinalConditionDescription	String	Mapped to CR210 in the ASC X12 278 TR3.
oxygenEquipmentType	String	Describes the type of oxygen equipment authorized.
oxygenEquipmentTypeCode	String	Code indicating the oxygen equipment type. Refer to the ASC X12 278 TR3 for the full list of oxygen equipment codes.
oxygenFlowRate	String	Describes the oxygen flow rate in liters per minute.
oxygenDailyUseCount	String	Describes the number of times per day the patient must use oxygen.
oxygenUsePeriodHourCount	String	Describes the number of hours per period of oxygen use.
oxygenOrderText	String	Free-form description of special orders for the respiratory therapist.
oxygenDeliverySystemType	String	Describes the type of oxygen delivery system, if one was prescribed.
oxygenDeliverySystemTypeCode	String	Code for the oxygen delivery system. Refer to the ASC X12 278 TR3 (Health Care Services Review and Response) for the full list of oxygen delivery system codes.
renderingProviders	Object array	Object providing information about the provider(s) who rendered/will render the service. Refer to the renderingProviders table for field definitions.
procedures	Object array	Object providing information about the medical procedure(s) performed during the service. Refer to the Procedures table for field definitions.

Service Reviews status and statusCode definitions
statusCode	status	Definition
A1	Certified in Total	The health plan fully authorized the request. The resource has a certificationNumber you can use on an 837 transaction if services were preauthorized.
A2	Certified - Partial	The health plan partially authorized the request. Check the procedures object array in the response for more details on the partial certification.
A3	Not Certified	The health plan denied the request. Check the statusReasons object array in the response for more details on this status.
A4	Pending	The payer is still processing the request. Check back later.
A6	Modified	The health plan indicated that the request was modified. Check back later.
C	Canceled	The health plan indicated that the request was canceled.
CT	Contact Payer	The requesting provider should contact the health plan. Refer to the payer object in the response for contact information.
NA	No Action Required	The health plan indicated that authorization is not required for the request.
51	Complete	The health plan indicated that the request is complete.
71	Term Expired	The term for the authorization has expired.

Service Reviews response definitions: Fields within statusReasons
Field	Type	Definition
value	String	Description of the reason for the current status of the service review.
code	String	The code representing the status reason. Refer to X12 External Code Source 886: Service Review Decision Reason Codes.

Service Reviews response definitions: Fields within validationMessages
Field	Type	Definition
errorMessage	String	Message describing an error.
field	String	Identifies the field or parameter in the service review with an error.
index	Integer	The array index, if applicable, of the item associated with an error.
code	String	The code identifying an error.

Service Reviews response definitions: Fields within payer
Field	Type	Definition
id	String	The health plan's Availity payer ID.
name	String	The health plan's name.
contactName	String	The full name of the health plan's contact person.
phone/extension/fax	String	The health plan's contact phone number/phone extension/fax number.
emailAddress	String	The health plan's email address.
url	String	The health plan's website address.

Service Reviews response definitions: Fields within requestingProvider
Field	Type	Definition
lastName/ firstName/middleName/suffix	String	The last name or business name/first name/middle name/suffix of the requesting provider.
npi	String	The requesting provider's NPI.
taxId	String	The requesting provider's tax ID number.
payerAssigned ProviderId	String	The requesting provider's payer-assigned provider ID.
submitterId	String	The requesting provider's health plan-specific submitter ID.
specialty	String	Describes the requesting provider's specialty.
specialtyCode	String	The code for the requesting provider's specialty. Refer to X12 External Code Source 682: Provider Taxonomy Codes.
addressLine1/addressLine2	String	The first and second lines of the requesting provider's address.
city/state/stateCode/zipCode	String	The requesting provider's city/state/state code/ZIP code.
contactName	String	The name for the requesting provider's contact person.
phone/extension/fax	String	The requesting provider's contact phone number/phone extension/fax number.
emailAddress	String	The requesting provider's email address.
url	String	The requesting provider's website address.

Service Reviews response definitions: Fields within subscriber
Field	Type	Definition
memberId	String	The health plan subscriber's member ID number.
lastName/firstName/ middleName/suffix	String	The last name/first name/middle name/suffix of the health plan subscriber.
addressLine1/ addressLine2	String	The first and second lines of the subscriber's address.
city/state/stateCode/zipCode	String	The health plan subscriber's city/state/state code/ZIP code.

Service Reviews response definitions: Fields within patient
Field	Type	Definition
lastName/firstName/middleName/suffix	String	The patient's last name/first name/middle name/suffix.
birthDate	String (date)	The patient's date of birth.
gender	String	The patient's gender.
genderCode	String	The code for the patient's gender. Values: F (female), M (male), U (unknown).
accountNumber	String	The service provider's patient identifier.
subscriberRelationship	String	The patient's relationship to the subscriber or policy holder.
subscriberRelationshipCode	String	The code for the patient's relationship to the subscriber or policy holder. Values with definitions in parentheses: 18 (Self) 01 (Spouse) 19 (Child) G8 (Other relationship)
addressLine1/addressLine2	String	The first and second lines of the patient's address.
city/state/stateCode/zipCode	String	The patient's city/state/state code/ZIP code.
status	String	Describes the patient's status.
statusCode	String	The code for the patient's status. Refer to X12 External Code Source 239: Patient Status Code.
condition	String	Describes the patient's condition.
conditionCode	String	The code for the patient's condition.
medicareCoverage	String	Indicates whether the patient has Medicare coverage.
prognosis	String	Describes the patient's prognosis.
prognosisCode	String	The code for the patient's prognosis. Values with definitions in parentheses: 2 (Guarded) 3 (Fair) 4 (Good) 5 (Very Good) 6 (Excellent) 7 (Less than six Months to Live) 8 (Terminal)

Service Reviews response definitions: Fields within diagnoses
Field	Type	Definition
qualifier	String	Indicates the healthcare information code set used for the diagnosis.
qualifierCode	String	The code for the qualifier. Refer to ASC X12 278 TR3 for the full list of diagnosis qualifier codes.
value	String	Description of the diagnosis/es.
date	Date	The date of the patient's diagnosis/es.

Service Reviews response definitions: Fields within transportLocations
Field	Type	Definition
name	String	The name of the transport location.
address Line1/addressLine2	String	The first and second lines of the location address.
city/state/stateCode/zipCode	String	The transport location's city/state/state code/ZIP code.

Service Reviews response definitions: Fields within renderingProviders
Field	Type	Definition
role	String	Describes the rendering provider's role.
roleCode	String	The code for the rendering provider's role. Refer to the ASC X12 278 TR3 (Health Care Services Review and Response) for the full list of provider codes.
lastName/firstName/middleName/suffix	String	The last name or business name/first name/middle name/suffix of the rendering provider.
npi	String	The rendering provider's NPI.
taxId	String	The rendering provider's tax ID number.
payerAssignedProviderId	String	The rendering provider's payer-assigned provider ID.
specialty	String	Describes the rendering provider's specialty.
specialtyCode	String	The code for the rendering provider's specialty. Refer to X12 External Code Source 682: Provider Taxonomy Codes.
addressLine1/addressLine2	String	The first and second lines of the rendering provider's address.
city/state/stateCode/zipCode	String	The rendering provider's city/state/state code/ZIP code.
contactName	String	The name for the rendering provider's contact person.
phone/extension/fax	String	The rendering provider's contact phone number/phone extension/fax number.
email Address	String	The rendering provider's email address.
url	String	The rendering provider's website address.

Service Reviews response definitions: Fields within procedures
Field	Type	Definition
status	String	Describes the authorization status of the procedure. Refer to the status and statusCodes table for definitions.
statusCode	String	The code for the authorization status. Refer to the status and statusCodes table for definitions.
statusReasons	Array	An array of reasons the health plan has given for the authorization status. Refer to the statusReasons table for definitions.
certificationIssueDate	String (date)	The date the health plan authorized the procedure.
certificationEffectiveDate	String (date)	The date the health plan's authorization will take effect.
certificationExpirationDate	String (date)	The date the health plan's authorization will expire.
certificationNumber	String	The health plan-assigned authorization number to be used on claims.
qualifier	String	Identifies the healthcare information code set used for the procedure code.
qualifierCode	String	The code for the qualifier. Refer to the ASC X12 278 TR3 for the full list of procedure qualifier codes.
value	String	Describes the procedure.
code	String	Code identifying the procedure. Refer to the ASC X12 278 TR3 (Health Care Services Review and Response) for code sources.
modifier1/modifier1Code/ modifier2/modifier2Code/ modifier3/modifier3Code/ modifier4/modifier4Code	String	Descriptions and codes identifying special circumstances related to the procedure.
description	String	Free-form description of the procedure written by the provider.
quantity	String	The quantity of procedures rendered.
quantityType	String	Describes the quantity type.
quantityTypeCode	String	The code for the quantity type.
fromDate	Date	The procedure's start date.
toDate	Date	The procedure's end date.
payerNotes	Object array	Array of notes the health plan added to the procedure. The text of notes is included in the procedures.payerNotes.message field.
traceNumbers	String array	An array of trace numbers the health plan assigned to the procedure.

GET/v2/claim-statuses/{id} parameters
Parameter	Type	Definition
id	Path string (required)	The unique response ID from your initial request.
Accept	Header string (optional)	Allows you to specify application/json or application/xml

DELETE/v1/claim-statuses/{id} parameters
Parameter	Type	Definition
id	Path string (required)	The unique response ID from your initial request.
Accept	Header string (optional)	Allows you to specify application/json or application/xml

curl --request GET \
  --url 'https://api.availity.com/availity/v1/claim-statuses?payer.id=REPLACE_THIS_VALUE&
submitter.lastName=REPLACE_THIS_VALUE&submitter.firstName=REPLACE_THIS_VALUE&submitter.
middleName=REPLACE_THIS_VALUE&submitter.suffix=REPLACE_THIS_VALUE&submitter.id=REPLACE_THIS
_VALUE&providers.lastName=REPLACE_THIS_VALUE&providers.firstName=REPLACE_THIS_VALUE&providers.
middleName=REPLACE_THIS_VALUE&providers.suffix=REPLACE_THIS_VALUE&providers.npi=REPLACE_THIS_
VALUE&providers.taxId=REPLACE_THIS_VALUE&providers.payerAssignedProviderId=REPLACE_THIS_VALUE&
subscriber.memberId=REPLACE_THIS_VALUE&subscriber.lastName=REPLACE_THIS_VALUE&subscriber.first
Name=REPLACE_THIS_VALUE&subscriber.middleName=REPLACE_THIS_VALUE&subscriber.suffix=REPLACE_THIS
_VALUE&patient.lastName=REPLACE_THIS_VALUE&patient.firstName=REPLACE_THIS_VALUE&patient.middle
Name=REPLACE_THIS_VALUE&patient.suffix=REPLACE_THIS_VALUE&patient.birthDate=REPLACE_THIS_VALUE& 
patient.genderCode=REPLACE_THIS_VALUE&patient.accountNumber=REPLACE_THIS_VALUE&patient.subscriber
RelationshipCode=REPLACE_THIS_VALUE&fromDate=REPLACE_THIS_VALUE&toDate=REPLACE_THIS_VALUE&claim
Number=REPLACE_THIS_VALUE&claimAmount=REPLACE_THIS_VALUE&facilityTypeCode=REPLACE_THIS_VALUE&
frequencyTypeCode=REPLACE_THIS_VALUE' \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json'

$ curl -i -X GET https://api.availity.com/availity/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=PATIENT
LASTNAME&patient.firstName=PATIENTFIRSTNAME&patient.birthDate=1999-09-09&patient.
genderCode=M&patient.accountNumber=PAT1ENTACC0UNTNUMB3R&patient.subscriberRelationship
Code=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/availity/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/availity/v1/claim-statuses?
        }
    },
    "claimStatuses": []
}

$ curl -i -X GET https://api.availity.com/availity/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/availity/v1/claim-statuses?id=-1437397854912689422
        }
    },
    "claimStatuses": [
        {
            "links": {
                "self": {
                    "href": "https://api.availity.com/availity/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"
            }
        }
    ]
}

$ curl -i -X GET https://api.availity.com/availity/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/availity/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"
}

$ curl -i -X DELETE https://api.availity.com/availity/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

HTTP status codes for GET/v1/claim-statuses and GET/v1/claim-statuses/{id}
Code	Description
200	Your request has been successfully fulfilled.
202	The resource has not yet received a response from the health plan. You should try again later.
400	The health plan indicated that an error with the request. The resource should have a list of validationMessages. Correct and resubmit the request.
404	The resource did not find a claim status with the ID that you specified.
504	The resource did not receive a response from the health plan within the time allotted. You should try again later.

HTTP status codes for DELETE/v1/claim-statuses/{id}
Code	Description
204	Availity has deleted the claim status from our system.
404	The resource did not find a claim with the ID number specified.

Claim Statuses response definitions: Primary result set
Field	Type	Definition
id	String	The unique response ID from your initial request.
customerId	String	The Availity customer ID of the organization that submitted the claim. Availity may ask for this ID during support calls.
createdDate	String (date)	The date and time this item was created in Availity's system.
updatedDate	String (date)	The date and time this item was last updated.
expirationDate	String (date)	The date and time this item will be removed from Availity's system.
controlNumber	String	An Availity-assigned tracing number assigned to the transaction with the payer.
status	String	The current status of the claim. See X12 External Code Source 508: Claim Status Codes.
statusCode	String	A code indicating the current claim status. See X12 External Code Source 508: Claim Status Codes.
payer	Object	Object providing identifying and contact information about the patient's health plan. Definitions for the fields within this object are omitted for brevity; see the X12 276/277 TR3 (Health Care Claim Status Request and Response) for more information.
submitter	Object	Object providing information about identifying and contact information the organization or person who requested the claim status. Definitions for the fields within this object are omitted for brevity; see the X12 276/277 TR3 (Health Care Claim Status Request and Response) for more information.
providers	Array	Array providing information about the service provider(s) from the original claim. Definitions for the fields within this object are omitted for brevity; see the X12 276/277 TR3 (Health Care Claim Status Request and Response) for more information.
patient	Object	Object providing identifying and contact information about the patient for whom the original claim was filed. Definitions for the fields within this object are omitted for brevity; see the X12 276/277 TR3 (Health Care Claim Status Request and Response) for more information.
subscriber	Object	Object providing identifying and contact information about the health plan subscriber. Definitions for the fields within this object are omitted for brevity; see the X12 276/277 TR3 (Health Care Claim Status Request and Response) for more information.
fromDate	String (date)	The beginning date specified in the initial claim status inquiry request.
toDate	String (date)	The end 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 processed by the health plan.
facilityTypeCode	String	The code identifying where services were performed for an institutional claim. See X12 External Code Source 237: Place of Service Codes for Professional Claims (professional) or External Code Source 236: Uniform Billing Claim Form Bill Type (institutional).
facilityType	String	Description of the facility type.
frequencyTypeCode	String	The code identifying the frequency of services. See X12 External Code Source 235: Claim Frequency Type Code.
frequencyType	String	Description of the claim frequency type. See X12 External Code Source 235: Claim Frequency Type Code.
claimCount	String	The total number of unique claims reported in this claim status response.
claimStatuses	Object	Object providing information on the claim statuses returned. See the claimStatuses table for field definitions.

Claim Statuses response definitions: Fields within claimStatuses
Field	Type	Definition
traceId	String	The health plan's unique reference ID for this claim.
claimControlNumber	String	The health plan's unique identifier for the originally submitted/processed claim.
facilityTypeCode	String	The code identifying where services were or may have been performed. See X12 External Code Source 237: Place of Service Codes for Professional Claims (professional) or External Code Source 236: Uniform Billing Claim Form Bill Type (institutional).
facilityType	String	Description of the facility type.
frequencyTypeCode	String	The code identifying the frequency of services. See X12 External Code Source 235: Claim Frequency Type Code.
frequencyType	String	Description of the claim's frequency. See X12 External Code Source 235: Claim Frequency Type Code.
patientControlNumber	String	The service provider's reference identifier for the patient included on the original claim.
pharmacyPrescriptionNumber	String	The pharmacy prescription number from the original claim.
voucherNumber	String	The voucher number returned from the health plan.
claimIdentificationNumber	String	An identifier from the original claim that was assigned by a clearinghouse or intermediary.
fromDate	String (date)	The date the service began.
toDate	String (date)	The date the service ended.
statusDetails	Array	Array providing status, required action, and paid information reported for the original claim. See the claimStatuses.statusDetails table for field definitions.
serviceLines	Object	Object providing information about the service line for the original claim. See the claimStatuses.serviceLines table for field definitions.

Claim Statuses response definitions: Fields within claimStatuses.statusDetails
Field	Type	Definition
category	String	Describes the logical grouping associated with the claim. See X12 External Code Source 507: Claim Status Category Codes.
categoryCode	String	Code indicating the category of the associated claim status code. See X12 External Code Source 507: Claim Status Category Codes.
status	String	Describes the status of the claim. See X12 External Code Source 508: Claim Status Codes.
statusCode	String	The code for the claim's status. See X12 External Code Source 508: Claim Status Codes.
entity	String	Describes the organizational entity, physical location, or individual associated with the claim status code.
entityCode	String	The code identifying the entity associated with the claim status. See the X12 276/277 (Healthcare Claim Status Request and Response) TR3 for the full list of codes.
effectiveDate	String (date)	The effective date for the status information.
claimAmount	String	The monetary charge amount for the original claim.
claimAmountUnits	String	The units used for the claim amount.
paymentAmount	String	The amount paid by the health plan for the original claim.
paymentAmountUnits	String	The units used for the paid amount.
finalizedDate	String (date)	The date the original claim was finalized/adjudicated.
remittanceDate	String (date)	The date the original claim was paid by the health plan.
checkNumber	String	The check or EFT trace number that paid the original claim.

Claim Statuses response definitions: Fields within claimStatuses.serviceLines.statusDetails
Field	Type	Definition
category	String	Describes the logical grouping associated with the service line. See X12 External Code Source 507: Claim Status Category Codes.
categoryCode	String	The code for the service line's category. See X12 External Code Source 507: Claim Status Category Codes.
status	String	Describes the claim status associated with this service line. See X12 External Code Source 508: Claim Status Codes.
statusCode	String	The status code for the status inquiry associated with this service line. See X12 External Code Source 508: Claim Status Codes.
entity	String	Describes the organizational entity, physical location, or individual associated with the claim status code.
entityCode	String	The code for the entity associated with the claim status. See the X12 276/277 (Healthcare Claim Status Request and Response) TR3 for the full list of codes.
effectiveDate	String	The effective date for the status information.
claimAmount	String	The charge amount for the original claim.
claimAmountUnits	String	The units used for the claim amount.
finalizedDate	String	The amount paid by the health plan for the original claim.
remittanceDate	String	The units used for the paid amount.
checkNumber	String	The check or EFT number that paid the claim associated with this service line.

	Path	Function
1	POST/v1/dental-claims	Create a dental claim asynchronously. To submit a dental claim, make a valid request and receive a location header containing a URL you can query for your result.
2	GET/v1/dental-claims/{id}	Retrieve a particular dental claim by ID number. (Replace {id} with a real ID number.)

Dental Claims demo response scenarios
Response scenario ID	Method	HTTP status	Definition
DC-Create-Success-i	POST	202	Availity has successfully received the member's claim information to submit to the health plan.
DC-Create-Rejected-i	POST	400	Your request failed Availity's input validation rules.
DC-InProgress-i	GET (use {id} 12345)	202	Availity is processing the request.
DC-Complete-i	GET (use {id} 12345)	200	Availity has successfully processed your claim and it has been sent to the health plan.

$ curl -i -X GET https://api.availity.com/availity/v1/configurations?
type=dental-claims&payerId=BCBSF&subtypeId=CLAIM

POST/v1/dental-claims parameters
Parameter	Type	Definition
dentalClaims	Body object (optional)	Represents the details of the dental claim you are creating. See the request body for possible fields. See Response definitions for field definitions.
Content-Type	Header string (optional)	Allows you to specify application/json or application/xml]
Accept	Header string (optional)	Allows you to specify application/json or application/xml

 {
    "type": "object",
    "properties": {
        "id": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "createdDate": {
            "type": "string",
            "format": "date-time",
            "$ref": "#/definitions/Primaryfields"
        },
        "updatedDate": {
            "type": "string",
            "format": "date-time",
            "$ref": "#/definitions/Primaryfields"
        },
        "expirationDate": {
            "type": "string",
            "format": "date-time",
            "$ref": "#/definitions/Primaryfields"
        },
        "message": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "customerId": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "requestTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "submitter": {
            "type": "object",
            "$ref": "#/definitions/Primaryfields"
        },
        "payer": {
            "type": "object",
            "$ref": "#/definitions/Payer"
        },
        "billingProvider": {
            "type": "object",
            "$ref": "#/definitions/BillingProvider"
        },
        "subscriber": {
            "type": "object",
            "$ref": "#/definitions/Primaryfields"
        },
        "patient": {
            "type": "object",
            "$ref": "#/definitions/Primaryfields"
        },
        "claimInformation": {
            "type": "object",
            "$ref": "#/definitions/ClaimInformation"
        }
    }
}

GET/v1/dental-claims/{id} parameters
Parameter	Type	Definition
id	Path string (required)	The unique response ID from your initial request, which can be used in follow-up requests.
Accept	Header string (optional)	Allows you to specify application/json or application/xml

curl --request POST \
  --url https://api.availity.com/availity/v1/dental-claims \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json' \
  --header 'content-type: application/json' \
  --data '{"id":"4352661346320384","createdDate":"2019-11-02T13:46:52.447Z",
"updatedDate":"2014-12-07T21:48:45.136Z","expirationDate":"2015-09-24T19:07:04.326Z",
"message":"34","customerId":"7553686947495936"[...]

$ curl -i -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/availity/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/availity/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

curl --request GET \
  --url https://api.availity.com/availity/v1/dental-claims/REPLACE_ID \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json'

$ curl -i -X GET https://api.availity.com/availity/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/availity/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

$ curl -i -X GET https://api.availity.com/availity/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/availity/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."
}

Status codes for POST/v1/dental-claims
HTTP status code	Definition
200	The claim has completed processing and will be submitted to the health plan.
202	Availity accepted the claim for processing. Poll the URL in the location header. The X-Status-Message header will contain additional details.
400	The claim request failed validation, either because it failed validation rules or was rejected by the health plan. 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	Availity was unable to parse your request. Correct the errors and resubmit the request.

Status codes for GET/v1/dental-claims
HTTP status code	Definition
200	The claim has completed processing and the response body contains the result.
202	Availity is currently processing or retrying your request.
404	Availity did not find a claim with the ID number you sent.

Dental Claims response definitions: Select fields within payer
Field	Type	Definition
naicCode	String	The payer's North American Industry Classification (NAIC) System code.
responsibilitySequenceCode	String	The responsibility sequence of the payer. Values: P (primary), S (secondary), or T (tertiary).
insuranceTypeCode	String	Code identifying the type of insurance policy within a specific insurance program. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.
claimFilingIndicatorCode	String	The payer's claim filing indicator code. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.

Dental Claims response definitions: Fields within billingProvider
Field	Type	Definition
specialtyCode	String	The billing provider's specialty type code. See X12 External Code Source 682: Healthcare Provider Taxonomy Codes.
payTo	Object	Object providing information about the billing provider's pay-to address, if different from the physical address.

Dental Claims response definitions: Fields within claimInformation
Field	Type	Definition
controlNumber	String	A unique reference identifier provided by the submitter and included in the original claim status request.
placeOfServiceCode	String	Code for the place of service for this claim. See X12 External Code Source 237: Place of Service Codes for Professional Claims.
frequencyTypeCode	String	Code specifiying the frequency of this claim. See X12 External Code Source 235: Claim Frequency Type Code.
providerSignatureOnFile	Boolean	Indicates whether a provider's signature is on file with the heath plan. Values: Y/N.
benefitsAssignmentCertification	String	A code indicating whether the insured has authorized the plan to remit payment directly to the provider. Values: Y, N, W (not applicable).
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. Values: Y, I (the provider has not collected a signature AND state or federal laws do not require it).
specialProgramCode	String	A code indicating whether the services were rendered under a special dental program. Values: 01 (EPSDT or Child Health Assessment Program), 02 (Physically Handicapped Children's Program – Medicaid only), 03 (Special Federal Funding – Medicaid only), 05 (Disability – Medicaid only).
delayReasonCode	String	A code indicating the reason for a delay when a claim is submitted past the contracted date of filing limitations. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.
appliancePlacementDate	String (date)	The date an orthodontic appliance was placed, if applicable.
serviceFromDate	String (date)	The date the service began.
serviceToDate	String (date)	The date the service ends/ended.
orthodonticClaim	Boolean	Indicates whether the dental claim was orthodontic. Values: Y/N.
orthodonticTreatmentMonths	String	Indicates the estimated number of months the orthodontic treatment will last, if applicable.
orthodonticTreatmentRemaining Months	String	The number of months remaining for the orthodontic treatment, if applicable.
patientPaidAmount	String	The amount the patient has already paid toward the claim.
serviceAuthorizationException Code	String	Service authorization exception code for this claim. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.
payerClaimControlNumber	String	The payer claim control number for this claim.
priorAuthorizationNumber	String	The prior authorization number for this claim.
claimIdentifier	String	The claim's trace number.
accidentCauseCode1/2	String	If an accident occurred to cause the claim, indicates the related/accident cause code. Values: AA (auto accident), EM (employment), OA (other accident).
accidentStateCode	String	The state where the accident occurred, if applicable.
accidentDate	String (date)	The date on which the accident occurred, if applicable.
toothStatuses	Object array	Object providing status information on the patient's teeth. Contains fields for tooth identification and status codes. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields and code sources.
supplementalInformation	Object array	Object providing supplemental information (i.e., additional paperwork) about the dental claim. Contains fields for the report type code, transmission code, and control number. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields and code sources.
contractAmount	String	The contracted monetary amount.
contractPercentage	String	The contracted allowance or charge percent.
contractCode	String	Code identifying a contract type. Values: 02 (per diem); 03 (variable per diem); 04 (flat); 05 (capitated); 06 (percent); 09 (other).
contractTermsDiscount Percentage	String	Terms discount percentage available to the purchaser if an invoice is paid on or before the Terms Discount Due Date.
contractVersion	String	The current contract version.
notes	Object	Object that provides notes on the dental claim in a message field.
diagnoses	Object	Object providing information about the diagnoses involved in the dental claim. Contains fields for the diagnosis qualifier and code. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields and code sources.
referringProvider	Object	Object providing identifying and contact information about the referring provider, including the referral number. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
primaryCareProvider	Object	Object providing identifying and contact information about the patient's primary care provider. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
renderingProvider	Object	Object providing identifying and contact information about the provider who rendered the service, including the referral number. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
serviceFacility	Object	Object providing identifying and contact information about the facility where the service was rendered. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
assistantSurgeon	Object	Object providing identifying and contact information about the assistant surgeon, if applicable. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
supervisingProvider	Object	Object providing identifying and contact information about the supervising provider, if applicable. See the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
otherPayers	Object array	Object providing identifying and contact information about other payers involved in the dental claim. See the claimInformation.otherPayers table for select field definitions.
serviceLines	Object array	Object providing information about the service lines for the dental claim. See the claimInformation.serviceLines table for select field definitions.

Dental Claims response definitions: Select fields within claimInformation.otherPayers
Field	Type	Definition
responsibilitySequenceCode	String	The responsibility sequence of the additional payer. Values: P (primary), S (secondary), or T (tertiary).
insuranceTypeCode	String	Code identifying the type of insurance policy within a specific insurance program. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.
claimFilingIndicatorCode	String	The additional payer's claim filing indicator code. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.
name	String	The additional payer's name.
id	String	The additional payer's ID.
claimPaidDate	String	The date this payer paid the claim.
claimOfficeNumber	String	The additional payer's claim office number.
priorAuthorizationNumber	String	The non-destination (COB) payer's prior authorization number.
referralNumber		The non-destination (COB) payer's referral number.
claimControlNumber		Number assigned by the additional payer to identify a claim.
paidAmount	String
remainingPatientLiabilityAmount	String	The amount of the patient's remaining liability for the claim.
nonCoveredAmount	String	The amount this payer did not cover.
benefitsAssignment Certification	Boolean	A code indicating whether the insured has authorized this payer to remit payment directly to the provider. Values: Y, N, W (not applicable).
informationReleaseCode	String	Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Values: Y, I (the provider has not collected a signature AND state or federal laws do not require it).
subscriberRelationshipCode	String	Code representing patient's relationship to this payer's subscriber. See the X12 837 TR3 (Health Care Claim: Dental) for the full list of codes.
subscriber	Object	Object providing identifying and contact information for this payer's subscriber. Definitions for the fields within this object are omitted for brevity; see the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.
medicareOutpatient AdjudicationInformation	Object	Object providing information about Medicare outpatient adjudication; required when outpatient adjudication information is reported in the remittance advice. See the claimInformation. otherPayers.medicareOutpatientAdjudication Information table for field definitions.
claimAdjustmentGroups	Object array	Object providing information about claim-level adjustments for this payer. Definitions for the fields within this object are omitted for brevity; see the X12 837 TR3 (Health Care Claim: Dental) for more information on these fields.

Dental Claims response definitions: Fields within claimInformation.serviceLines
Field	Type	Definition
controlNumber	String	The service line control number.
procedureCode	String	Code for the procedure performed. See X12 External Code Source 135: American Dental Association.
modifierCode1/2/3/4	String	Codes indicating special circumstances related to the performance of the service. See X12 External Code Source 135: American Dental Association.
procedureDescription	String	A free-form description of the procedure performed.
amount	String	The total charge amount for this service line.
placeOfServiceCode	String	Code for the place of service for this service line if different from the overall claim place of service. See X12 External Code Source 237: Place of Service Codes for Professional Claims.
cavityDesignationCode1/2/3/4/5	String	Codes designating the area of the oral cavity in which service was rendered. See X12 External Code Source 135: American Dental Association.
prostheticCode	String	The code indicating the placement status of the dental prosthetic, if applicable. Values: I (initial placement); R (replacement).
quantity	String	The number of paid units of service.
diagnosisCodePointer1/2/3/4	String	A pointer to the first, second, third, and fourth diagnosis codes in this service.
serviceDate	String (date)	The date the service was performed.
priorPlacementDate	String (date)	The date a prior dental appliance was placed, if applicable.
appliancePlacementDate	String (date)	The date the current appliance was placed, if applicable.
replacementDate	String (date)	The date the current appliance should be replaced, if applicable.
treatmentStartDate	String (date)	The date treatment began.
treatmentEndDate	String (date)	The date treatment ended.
toothInformation	Object array	Object providing information about the teeth involved in this service, including toothCode and toothSurface fields. See X12 External Code Source 135: American Dental Association and the X12 837 TR3 (Health Care Claim: Dental).
contractTypeCode	String	Code identifying a contract type. Values: 02 (per diem), 03 (variable per diem), 04 (flat), 05 (capitated), 06 (percent), 09 (other).
contractAmount	String	The contracted monetary amount.
contractPercentage	String	The contracted allowance or charge percent.
contractCode	String	Reference information for the contract, required when information is different from that given at the claim level.
contractTermsDiscount Percentage	String	Terms discount percentage available to the purchaser if an invoice is paid on or before the terms discount due date.
contractVersion	String	The current contract version (an additional contract identifier).
priorAuthorizationNumber	String	The prior authorization number for this claim. Required when the service line involved a prior authorization number that differs from the number reported at the claim level.
referralNumber	String	The referral number for this claim. Required when the payer assigns a referral number and a referral is involved.
salesTax	String	The sales tax amount charged for this service.
renderingProvider	Object	Object providing identifying and contact information about the provider who rendered the service. Definitions for the fields within this object are omitted for brevity.
assistantSurgeon	Object	Object providing identifying and contact information about the assistant surgeon, if applicable. Definitions for the fields within this object are omitted for brevity.
supervisingProvider	Object	Object providing identifying and contact information about the supervising provider, if applicable. Definitions for the fields within this object are omitted for brevity.
serviceFacility	Object	Object providing identifying and contact information about the facility where the service was performed. Definitions for the fields within this object are omitted for brevity.
adjudicationInformation	Object	Object providing adjudication information for this service line. See the adjudicationInformation table for field definitions.

Dental Claims response definitions: Fields within claimInformation.serviceLines.adjudicationInformation
Field	Type	Definition
payerId	String	The payer ID for the payer that adjudicated the service line.
paidAmount	String	The monetary amount paid for this service line.
procedureCode	String	Procedure code used to pay this service line. See X12 External Code Source 135: American Dental Association.
modifierCode1/2/3/4	String	Code that identifies special circumstances related to the performance of the service. See X12 External Code Source 135: American Dental Association.
procedureDescription	String	A free-form description to clarify the procedure.
quantity	String	The number of paid units from the remittance advice.
lineNumber	String	LX Assigned Number, required only for bundling of service lines.
claimPaidDate	String (date)	The date the claim was paid.
remainingPatientLiability Amount	String	The amount of the patient's remaining liability for this service line.
claimAdjustmentGroups	Object array	Object providing information on line adjustments made to the claim. Contains fields for adjustment groups, adjustment reason codes, and adjustment amounts. See the X12 827 TR3 (Dental) for more information on these fields.

Dental Claims response definitions: Fields within claimInformation.otherPayers.medicareOutpatientAdjudicationInformation
Field	Type	Definition
reimburseRate	String	Rate used when payment is based on a percentage of applicable charges.
payableAmount	String	The HCPCS payable amount.
claimPaymentRemarkCode1 /2/3/4/5	String	Reference codes; required when returned in the remittance advice.
nonPayable ProfessionalComponentBilledAmount	String	The professional component amount billed but not payable.

	Path	Function
1	POST/v1/professional-claims	Create a professional claim predetermination asynchronously. To submit a claim predetermination, make a valid request and receive a response with a location header containing a URL you can query for your result.
2	GET/v1/professional-claims/{id}	Retrieve a particular professional claim predetermination. Replace {id} with the response ID from your initial request.

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

CCE – Professional demo response scenarios
Response scenario ID	Method	HTTP status	Definition
CCEP-Success-i	GET (use {id} 123)	200	Availity has successfully retrieved the member's claim predetermination information from the health plan.
CCEP-Accepted-i	POST	202	Availity is in the process of retrieving the member's claim predetermination information from the health plan.
CCEP-RequestErrors1-i	POST	400	Your request failed Availity's input validation rules.
CCEP-RequestErrors2-i	POST	400	Your request failed Availity's input validation rules.
CCEP-RequestParseError-i	POST	500	Availity was unable to parse your request.
CCEP-MultiServiceLines-i	GET (use {id} 54321)	200	Availity has successfully retrieved the member's claim predetermination information, which contains multiple service lines.

POST/v1/professional-claims parameters
Parameter	Type	Definition
professionalClaim	Body object (optional)	Represents the details of the new professional claim predetermination you are creating. See the request body for possible fields. See Response definitions for field definitions.
Content-Type	Header string (optional)	Allows you to specify application/json or application/xml
Accept	Header string (optional)	Allows you to specify application/json or application/xml

{
    "type": "object",
    "properties": {
        "id": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "createdDate": {
            "type": "string",
            "format": "date-time",
            "$ref": "#/definitions/Primaryfields"
        },
        "updatedDate": {
            "type": "string",
            "format": "date-time",
            "$ref": "#/definitions/Primaryfields"
        },
        "expirationDate": {
            "type": "string",
            "format": "date-time",
            "$ref": "#/definitions/Primaryfields"
        },
        "message": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "customerId": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "requestTypeCode": {
            "type": "string",
            "$ref": "#/definitions/Primaryfields"
        },
        "submitter": {
            "type": "object",
            "$ref": "#/definitions/Primaryfields"
        },
        "payer": {
            "type": "object",
            "$ref": "#/definitions/payer"
        },
        "billingProvider": {
            "type": "object",
            "$ref": "#/definitions/billingProvider"
        },
        "patient": {
            "type": "object",
            "$ref": "#/definitions/Primaryfields"
        },
        "claimInformation": {
            "type": "object",
            "$ref": "#/definitions/claimInformation"
        },
        "payerSpecificFlags": {
            "type": "array",
            "$ref": "#/definitions/Primaryfields"
        }
    }
}
                

GET/v1/professional-claims/{id} parameters
Parameter	Type	Definition
id	Path string (required)	The unique response ID from your initial request, which can be used in follow-up requests.
Accept	Header string (optional)	Allows you to specify application/json or application/xml

curl -i -H "Content-Type: application/json" -X POST https://api.availity.com/
availity/v1/professional-claims -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"
      }
    ]
  }
}

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/availity/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

$ curl -i -X GET https://api.availity.com/availity/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/availity/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

$ curl -i -X GET https://api.availity.com/availity/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

{
  "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
      }
    } ]
  }
}

HTTP status codes for CCE – Professional
Code	Status	Definition
200	OK	We have processed your request and the response body contains the result.
202	Accepted	We are currently processing or retrying your request.
400	Bad Request	Your claim predetermination request failed validation. You can correct the errors and resubmit.
404	Not Found	We did not find a claim predetermination with the ID you sent.
500	Internal Server Error	The health plan did not respond due to a server error. Please try your request again later.
504	Gateway Timeout	The health plan did not respond after several retry attempts. Please try your request again later.

CCE – Professional response definitions: Primary objects and fields
Field	Type	Definition
id	String	The unique response ID from your initial request, which can be used in follow-up requests.
createdDate	String (date-time)	The date and time this item was created in Availity's system.
updatedDate	String (date-time)	The date and time this item was last updated.
expirationDate	String (date-time)	The date and time this item will be removed from Availity's system.
message	String	A text message with information about the claim.
customerId	String	The Availity customer ID of the organization that submitted this claim predetermination. Availity may ask for this ID during support calls.
requestTypeCode	String	The type of request. Use PRE_DETERMINATION for this transaction.
submitter	Object	Object providing identifying and contact information about the submitter of the claim predetermination. Definitions for the fields within this object are omitted for brevity; see the X12 837 TR3 (Health Care Claim: Professional) for more information on these fields.
payer	Object	Object providing information about the payer involved in the claim. See the Payer table for select field definitions.
billingProvider	Object	Object providing identifying and contact information about the billing provider involved in the claim predetermination. See the billingProvider table for select field definitions.
subscriber	Object	Object providing identifying and contact information about the health plan subscriber involved in the claim predetermination. See the Subscriber table for select field definitions.
patient	Object	An object providing identifying and contact information about the patient involved in the claim predetermination (if different from the subscriber). Definitions for the fields within this object are omitted for brevity; see the X12 837 TR3 (Health Care Claim: Professional) for more information on these fields.
claimInformation	Object	Object providing further information about the claim predetermination. See the claimInformation table for select field definitions.
payerSpecificFlags	Array	Array including the name and value of payer-specific flags.

CCE – Professional response definitions: Select fields within payer
Field	Type	Definition
naicCode	String	The payer's North American Industry Classification (NAIC) System code.
responsibilitySequenceCode	String	The responsibility sequence of the payer. Options: P (primary), S (secondary), or T (tertiary).
insuranceTypeCode	String	Code identifying the type of insurance policy within a specific insurance program. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
claimFilingIndicatorCode	String	The payer's claim filing indicator code. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.

CCE – Professional response definitions: Select fields within billingProvider
Field	Type	Definition
specialtyCode	String	Specifies the requesting provider's specialty using a taxonomy code. See X12 External Code Source 682: Provider Taxonomy Codes.
stateLicenseNumber	String	The billing provider's state medical license number.
upin	String	The billing provider's Unique Personal Identification Number (UPIN).
payerAssignedProviderId	String	The billing provider's ID number assigned by the payer.
payToAddress	Object	Object containing fields for the billing provider's pay-to address, if different from the physical address.

CCE – Professional response definitions: Select fields within subscriber
Field	Type	Definition
totalDeductible	String	The total amount of the subscriber's health insurance deductible.
accumulatedDeductible	String	The subscriber's accumulated deductible.
remainingDeductible	String	The amount the subscriber has left to pay on the deductible.
onHold	Boolean	Indicates whether the subscriber is on hold. Options: Y/N.
holdReasons	Array	Array describing reasons for the hold.

CCE – Professional response definitions: Fields within claimInformation
Field	Type	Definition
controlNumber	String	A unique reference identifier provided by the submitter and included in the original claim request.
placeOfServiceCode	String	Code identifying where services were or may be performed. See X12 External Code Source 237: Place of Service Codes for Professional Claims.
frequencyTypeCode	String	Code specifying the frequency of the claim. See X12 External Code Source 235: Claim Frequency Type Code.
providerSignatureOnFile	Boolean	Indicates whether the provider signature is on file. Options: Y/N.
providerAcceptAssignmentCode	String	Code indicating whether the provider accepts assignment from the payer. Options: A (assigned), B (accepted on clinical lab services only), C (not assigned).
benefitsAssignmentCertification	String	Indicates whether the insured has authorized the plan to remit payment directly to the provider. Options: Y, N, W (not applicable).
informationReleaseCode	String	Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. Options: Y, I (the provider has not collected a signature AND state or federal laws do not require it).
patientSignatureSourceCode	String	Code indicating how the patient or subscriber authorization signatures were obtained and how the provider retains them. Required when a signature was executed on the patient's behalf under state or federal law.
specialProgramCode	String	A code indicating whether the services were rendered under a special program. Options: 02 (Physically Handicapped Children's Program – Medicaid only), 03 (Special Federal Funding – Medicaid only), 05 (Disability – Medicaid only), 09 (Second Opinion or Surgery – Medicaid only).
delayReasonCode	String	A code indicating the reason for a delay when a claim is submitted past the contracted date of filing limitations. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
serviceTypeCode	String	Code identifying the type of service to be performed. See the ASC X12 270/271 TR3 (Health Care Eligibility Benefit Inquiry and Response) for the full list of service type codes.
accidentCauseCode1/2	String	If an accident occurred to cause the claim, these fields indicate the first and second related/accident cause codes. Options: AA (auto accident), EM (employment), OA (other accident).
accidentStateCode	String	Two-digit code identifying the state in which the accident occurred, if applicable. See X12 External Code Source 22: States and Provinces.
accidentDate	String (date)	The date on which the accident occurred, if applicable.
onsetOfCurrentIllnessOrSymptomDate	String (date)	Date of the onset of acute symptoms of the current illness or condition.
initialTreatmentDate	String (date)	Date when initial treatment for the current illness or condition began. Required when the date is known to impact adjudication for claims involving spinal manipulation, physical therapy, occupational therapy, speech language pathology, dialysis, optical refractions, or pregnancy.
lastSeenDate	String (date)	Date that the patient was last seen by the attending or supervising physician for the qualifying medical condition related to the services to be performed.
acuteManifestationDate	String (date)	Date of acute manifestation of a chronic condition. Required only when the condition is acute or an acute manifestation of a chronic condition; the claim involves spinal manipulation; and the payer is Medicare.
lastMenstrualPeriodDate	String (date)	Date of the patient's last menstrual period. Required when the services on the claim are related to the patient's pregnancy.
lastXrayDate	String (date)	Date of patient's last x-ray. Required when the claim involves spinal manipulation and an x-ray was taken.
hearingAndVisionPrescriptionDate	String (date)	Date when a hearing device or vision frames/lenses were prescribed and billed on this claim.
disabilityPeriodStartDate	String (date)	Date when the patient became unable to perform duties associated with his/her work.
disabilityPeriodEndDate	String (date)	Date when the patient has returned or will return to work.
lastWorkedDate	String (date)	Date the patient last worked. Required on claims where this information is necessary for adjudication (e.g., workers compensation claims).
authorizedReturnToWorkDate	String (date)	The date the provider has authorized the patient to return to work. Required on claims where this information is necessary for adjudication (e.g., workers compensation claims).
admissionDate	String (date)	Date the patient was/will be admitted to the hospital, if applicable.
dischargeDate	String (date)	Date the patient was or will be discharged from the hospital, if applicable.
assumedCareDate	String (date)	Date the patient's care was assumed by another provider during post-operative care.
relinquishedCareDate	String (date)	Date the provider filing this claim ceased post-operative care.
propertyAndCasualtyFirstContactDate	String (date)	Date the patient first consulted the service provider for this condition (not necessarily the initial treatment date). Only for property and casualty claims where state-mandated.
repricerReceivedDate	String (date)	Date required when a repricer is passing the claim onto the payer.
supplementalInformation	Array	Additional information about a claim predetermination included as a paper attachment, an electronic attachment transmitted in another functional group, or when the provider deems it necessary to identify additional information held at the provider's office but not submitted with the claim. See the claimInformation.supplementalInformation table for select field definitions.
contractTypeCode	String	Code identifying the contract type. Options: 01 (Diagnosis Related Group [DRG]), 02 (per diem), 03 (variable per diem), 04 (flat), 05 (capitated), 06 (percent), 09 (other).
contractAmount	String	The contracted monetary amount.
contractPercentage	String	The contracted allowance or charge percent.
contractCode	String	Code for the contract.
contractTermsDiscountPercentage	String	Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the term discount due date.
contractVersionIdentifier	String	Additional identifying number for the contract.
patientPaidAmount	String	Amount the patient has paid specifically toward this claim.
serviceAuthorizationException Code	String	Code identifying an exception to the mandate requiring authorization for specific service(s). See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
medicareCrossoverIndicator	Boolean	Required when the submitter is Medicare and the claim is a Medigap or coordination of benefits (COB) crossover claim. Options: Y (4801), N (regular crossover).
mammographyCertificationNumber	String	Certification number for a claim involving mammography services rendered by a certified mammography provider.
referralNumber	String	Referral number for the claim, if one was assigned by the payer and a referral is involved.
priorAuthorizationNumber	String	Prior authorization number for the claim, if one was assigned by the payer and the services were preauthorized.
payerClaimControlNumber	String	Control number required when this claim predetermination is a replacement or void to a previously adjudicated claim.
clinicalLaboratory ImprovementAmendmentNumber	String	Number required for all Clinical Laboratory Improvement Amendment (CLIA)-certified facilities performing CLIA-covered lab services.
repricedClaimReferenceNumber	String	Reference number required when the information is deemed necessary by the repricer.
adjustedRepricedClaimReferenceNumber	String	Reference number required when the information is deemed necessary by the repricer.
investigationalDeviceExemptionIdentifier	String	Identifier required when the claim involves an FDA-assigned investigational device exemption (IDE) number.
claimIdentifier	String	Identifer assigned by transmission intermediaries (e.g., automated clearinghouses) that must attach their own unique claim number.
medicalRecordNumber	String	Required when the provider needs to identify the actual medical record of the patient for future inquiries.
demonstrationProjectIdentifier	String	Identifier used to identify atypical claims (e.g., claims for a demonstration, special project, or clinical trial).
carePlanOversightNumber	String	Number required when the physician is billing Medicare for Care Plan Oversight (CPO).
claimNoteReferenceCode	String	Code identifying the functional area or purpose for a note about the claim. Options: ADD (additional information), CER (certification narrative), DCP (goals, rehabilitation potential, or discharge plans), DGN (diagnosis description), or TPO (third-party organization notes).
claimNoteText	String	Free-form content of the claim note.
ambulanceTransportReasonCode	String	Code indicating the reason for ambulance transport, if applicable. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
ambulanceTransportDistance	String	The distance traveled during the ambulance transport.
ambulanceTransport RoundTripPurposeDescription	String	Free-form description of the purpose for a round-trip ambulance transport, if applicable.
ambulanceTransport StretcherPurposeDescription	String	Free-form description justifying usage of a stretcher duirng ambulance service, if applicable.
spinalManipulation ServicePatientConditionCode	String	Code indicating the patient's condition for chiropractic claims involving spinal manipulation. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
spinalManipulationService PatientConditionDescription1/2	String	The first and second free-form descriptions of the patient's condition.
ambulanceCertifications	Array	Array containing information about the ambulance transport and condition codes. See the claimInformation.ambulanceCertifications table for select field definitions.
visionConditions	Array	Array containing information on the patient's vision condition(s). See the clamInformation.visionConditions table for select field definitions.
homeboundIndicator	Boolean	Indicates whether the patient is homebound. Required for Medicare claims when an independent laboratory renders an EKG tracing or optains a specimen from a homebound or institutionalized patient. Options: Y/N.
epsdtReferralCertification ConditionCodeAppliesIndicator	Boolean	Indicates whether the patient received an EPSDT referral when EPSDT is being billed in the claim. Options: Y/N.
epsdtReferralCondition Cide1/2/3	String	Codes for the condition of the EPSDT referral. Options: AV (available – not used; patient refused referral); NU (not used), S2 (under treatment), ST (new services requested).
diagnoses	Array	Array providing information about the patient's principal diagnosis. See the claimInformation.diagnoses table for field definitions.
anesthesiaRelated SurgicalPrincipalProcedure	String	Code for a principal surgical procedure that requires anesthesia. See X12 External Code Source 130: Healthcare Common Procedure Coding System (HCPCS).
anesthesiaRelatedSurgical OtherProcedure	String	Code for a secondary surgical procedure that requires anesthesia. See X12 External Code Source 130: Healthcare Common Procedure Coding System (HCPCS).
conditionInformation	Array	Array that includes the patient's condition code.
referringProvider	Object	Object providing identifying and contact information about the provider who referred the patient, if applicable. Definitions for the fields within this object are omitted for brevity.
primaryCareProvider	Object	Object providing identifying and contact information about the patient's primary care provider. Definitions for the fields within this object are omitted for brevity.
renderingProvider	Object	Object providing identifying and contact information about the provider who rendered/will render the service. Definitions for the fields within this object are omitted for brevity.
serviceFacility	Object	Object providing identifying and contact information about the facility where the service will be performed. Definitions for the fields within this object are omitted for brevity.
supervisingProvider	Object	Object providing identifying and contact information about the supervising provider, if applicable. Definitions for the fields within this object are omitted for brevity.
ambulancePickUpLocation	Object	Object providing address information about the location where an ambulance picked up the patient, if applicable. Definitions for the fields within this object are omitted for brevity.
ambulanceDropOffLocation	Object	Object providing address information about the location where an ambulance dropped off the patient, if applicable. Definitions for the fields within this object are omitted for brevity.
otherPayers	Array	Array including information about other payers involved in the claim predetermination. See the claimInformation.otherPayers table for select field definitions.
serviceLines	Array	Array providing information about the service lines for the claim. See the claimInformation.serviceLines table for select field definitions.
bundled	Boolean	Indicates whether the claim is bundled. Options: true/false.
messages	Array	Array of messages from the payer.
displayMessage	String	A display message from the payer.
totalCharges	String	Object providing information about the total charge amount for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalAllowed	Object	Object providing information about the total allowed amount for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalEstimated	Object	Object providing information about the total estimated amount for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalNotCovered	Object	Object providing information about the total amount not covered for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalCoPay	Object	Object providing information about the total copay amount. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalCoInsurance	Object	Object providing information about the total co-insurance amount. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalDeductible	Object	Object providing information about the total deductible amount. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalContractual	Object	Object providing information about the total contractual charge amount for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalProviderInitiated	Object	Object providing information about the total provider-initiated charge amount for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalProviderResponsibility	Object	Object providing information about the provider's total respoinsibility. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.
totalPatientLiability	Object	Object providing information about the patient's total liability for the claim predetermination. Includes fields for the amount, the description, code, and codeType for the amount, the procedure, and a Boolean field that indicates whether the patient is liable for this item.

CCE – Professional response definitions: Fields within claimInformation.supplementalInformation
Field	Type	Definition
reportTypeCode	String	Code indicating the title or contents of a document, report, or supporting item. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
reportTransmissionCode	String	Code defining timing, transmission method, or format by which the report was sent. See the X12 837 TR3 (Health Care Claim: Professional) for the full list of codes.
controlNumber	String	Control number for the supplemental information.