Enhanced Claim Status (claim-status 1.0.0)

The Enhanced Claim Status API consists of two workflows with two distinct calls in each:

searchBy276 + valueAdds277

searchBy276: Renders the standard ASC X12N 276 request for claim status information in a JSON format.
valueAdds277: Returns an ASC X12N 277 response combined with value-added information from the health plan merged into a single JSON API response. You must run an initial searchBy276 request before making a valueAdds277 request.

summarySearch and detailSearch

summarySearch: Search by service date, member ID, claim history, and/or check number to return high-level information about one or multiple claims.
detailSearch: Search by provider tax ID number/NPI and claim number to return detailed information about a single claim. You can make the detailSearch request indepedently or after running a summarySearch request.

Note: For more information about Availity's APIs, refer to the Availity API Guide.

Validation rules

The validation rules for Enhanced Claim Status can vary by plan, the type of claim requested, and the type of service to be performed. Availity organizes these rules and makes them available through the Configurations API, which documents the fields required to send an Enhanced Claim Status request and reports which values are valid for those fields.

In Configurations, the type name for Enhanced Claim Status is enhanced-claim-status. The subtypeId values for the various requests are as follows:

HIPAA_276 to view a health plan's validation rules for the standard X12 claim status inquiry.
VALUE_ADDS_277 to view validation rules for the valueAdds277 call.
SUMMARY to view validation rules for the summarySearch call.
DETAIL to view validation rules for the detailSearch call.

Here's an example of a Configurations request for an Enhanced Claim Status summarySearch for the payer Florida Blue:

curl --location --request GET
'https://api.availity.com/availity/v1/configurations?type=enhanced-claim-
status&subtypeId=SUMMARY&payerId=BCBSF' \

Refer to the Configurations reference section for details.

HTTP status codes


HTTP status codes for Enhanced Claim Status
Code	Description
200	Your request has been successfully processed.
400	The request failed validation or was otherwise invalid.
403	Requesting user is not allowed to view the request.
404	There is an issue with the URL the resource tried to access.
410	Response is outdated and too old for pick-up.
500	Unexpected error processing request.
502	The payer encountered an unexpected error processing the request outside of Availity's system.
503	Service is temporarily unavailable. Please try again later.
504	Processing took longer than expected and timed out. Please resubmit your request.

searchBy276

Make the standard ASC X12N 276 request for claim status information in a JSON format.

Endpoints


searchBy276 endpoints
	Path	Function
1	POST/clmsmgmt/claim-status/claim-status/v1/status/searchBy276	Perform a search for X12 276 claim status information.
2	GET/clmsmgmt/claim-status/claim-status/v1/status/searchBy276?id={id}	Replace {id} with the response ID returned in the URL of the initial POST request to "poll" whether the API has received the complete information from the payer.

Parameters


POST/searchBy276 parameters
Parameter	Type	Definition
filter	Body object (required)	Narrow the results of your search using the search filter body object. See the searchBy276 filter 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`


POST/searchBy276 search filters and definitions
Field	Type	Definition
offset	Integer (optional)	The zero-based starting index in the collection of the first item to return. Default = 0
limit	Integer (optional)	The maximum number of collection items to return for a single request. Minimum = 1, maximum = 50.
payerId	Query string (required)	The Availity payer ID of the health plan targeted in your search.
traceId	Query string (optional)	A unique identifier from the requester's system that can be linked to the AVAILITY_TRACE_ID. It identifies a specific request and can be used for research purposes.
fromDate	Query string (date-time) (required)	The service from (beginning) date.
toDate	Query string (date-time) (required)	The service to (end) date.
claimNumber	Query string (optional)	The health plan's identifier for the originally submitted claim.
claimAmount	Query string (optional)	The monetary amount of the claim.
frequencyTypeCode	Query string (optional)	The code identifying the frequency of services. See X12 External Code Source 235: Claim Frequency Type Code.
patientMemberId	Query string (optional)	The patient's health plan member identifier.
patientAccountNumber	Query string (optional)	Number that identifies the patient's health plan account.
patientLastName	Query string (required)	The patient's last name.
patientFirstName	Query string (required)	The patient's first name.
patientMiddleName	Query string	The patient's middle name.
patientSuffix	Query string (optional)	The patient's suffix.
patientBirthDate	Query string (date-time) (required)	The patient's date of birth.
patientSameAsSubscriber	Boolean (required)	Indicates whether the patient and health plan subscriber are the same person. Options: TRUE/FALSE.
patientGender	Query string (optional)	Indicates the patient's gender. Options: F (female), M (male), U (unknown)
providerLastName	Query string (required)	The last name or business name of the provider.
providerFirstName	Query string (optional)	The provider's first name.
providerMiddleName	Query string (optional)	The provider's middle name.
providerSuffix	Query string (optional)	The provider's suffix.
providerNpi	Query string (optional)	The provider's National Provider Identifier.
providerPayerAssignedId	Query string (optional)	The provider's identfier assigned by the payer.
providerTaxId	Query string (optional)	The provider's tax ID number.
subscriberLastName	Query string (optional)	The health plan subscriber's last name.
subscriberFirstName	Query string (optional)	The health plan subscriber's first name.
subscriberMiddleName	Query string (optional)	The health plan subscriber's middle name.
subscriberSuffix	Query string (optional)	The health plan subscriber's suffix.
subscriberMemberId	Query string (optional)	The health plan subscriber's member idenfication number.


GET/searchBy276 parameters
Parameter	Type	Definition
id	Query string (required)	The unique response ID from your initial request, which can be used in follow-up requests.
Accept	Header (optional)	Allows you to specify `application/json` or `application/xml`

Sample requests and responses

1. POST/searchBy276

Request:

curl --location --request POST 'https://qa-apps.availity.com/ms/api/availity/internal/clmsmgmt/claim-status/claim-status/internal/v1/status/searchBy276' \
--header 'Content-Type: application/json' \
--data-raw '{
    "payerId": "CSP01",
    "patientMemberId": "E7E03022034A",
    "providerLastName": "last",
    "providerNpi": "1003868548",
    "subscriberMemberId": "E7E03022034A",
    "requestType": "HIPAA_276",
    "subscriberLastName": "sublast",
    "patientLastName": "Last",
    "patientFirstName": "First",
    "patientBirthDate": "2000-01-01",
    "fromDate": "2023-01-01",
    "toDate": "2023-01-01",
    "patientSameAsSubscriber": false
}'

Response:

{
    "id": "2af91dd0-68e4-4721-bbab-4fd40139dc4b"
}

2. GET/searchBy276

Request:

Use the response ID from your POST response to perform the GET request:

curl --location --request GET 'https://qa-apps.availity.com/ms/api/availity/internal/
clmsmgmt/claim-status/claim-status/internal/v1/status/searchBy276?id=2af91dd0-68e4-4721-bbab-
4fd40139dc4b'

Response:

After Availity processes the request, the resource returns the claim status information:

{

    "items": [
        {
            "customerId": "1194",
            "claimNumber": "20210AK6672",
            "status": "PAID",
            "statusCode": "107",
            "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
            "categoryCode": "F1",
            "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
            "exchangeDate": "2021-01-25T11:23:20Z",
            "effectiveDate": "2020-08-10T00:00:00Z",
            "finalizedDate": "2020-08-10",
            "fromDate": "2020-07-25",
            "toDate": "2020-07-25",
            "amounts": {
                "BILLED": {
                    "value": "3700"
                },
                "INSURANCE_TOTAL_PAID": {
                    "value": "211.73"
                }
            },
            "payer": {
                "id": "050",
                "name": "ANTHEM BLUE CROSS BLUE SHIELD"
            },
            "submitter": {
                "lastName": "AVAILITY, LLC",
                "id": "680594620"
            },
            "providers": [
                {
                    "lastName": "AVAILITY, LLC",
                    "taxId": "789345127",
                    "npi": "1003868548"
                }
            ],
            "subscriber": {
                "lastName": "LEEJONES",
                "firstName": "DARREN",
                "memberId": "E7E508T98764"
            },
            "patient": {
                "lastName": "LEEJONES",
                "firstName": "DARREN",
                "birthDate": "1984-03-04",
                "accountNumber": "UNKNOWN",
                "memberId": "E7E508T98764",
                "subscriberRelationship": "SELF",
                "subscriberRelationshipCode": "18"
            },
            "controlNumber": "20210AK6672",
            "userId": "aka00000000001",
            "remittanceInfo": [
                {
                    "checkNumber": "3101312484",
                    "checkDate": "2020-08-14"
                }
            ],
            "statusDetails": [
                {
                    "statusCode": "107",
                    "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
                    "categoryCode": "F1",
                    "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
                    "effectiveDate": "2020-08-10T00:00:00Z"
                }
            ],
            "serviceLines": [
                {
                    "procedureQualifierCode": "HC",
                    "procedureQualifierCodeDescription": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
                    "procedureCode": "A0428",
                    "modifiers": {
                        "HH": "Mental hlth/substance abs pr"
                    },
                    "amounts": {
                        "BILLED": {
                            "detail": "USD",
                            "value": "3700"
                        },
                        "INSURANCE_TOTAL_PAID": {
                            "detail": "USD",
                            "value": "211.73"
                        }
                    },
                    "quantity": "1",
                    "controlNumber": "1",
                    "fromDate": "2020-07-25",
                    "toDate": "2020-07-25",
                    "statusDetails": [
                        {
                            "statusCode": "107",
                            "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
                            "categoryCode": "F1",
                            "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
                            "effectiveDate": "2020-08-10T00:00:00Z"
                        }
                    ],
                    "status": "PAID",
                    "statusCode": "107",
                    "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
                    "categoryCode": "F1",
                    "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
                    "effectiveDate": "2020-08-10T00:00:00Z"
                }
            ],
            "eligibleForValueAdds": true,
            "summary": false
        }
    ],
    "offset": 0,
    "limit": 50,
    "count": 1,
    "totalCount": 1,
    "completeCode": 4,
    "traceIds": {
        "AVAILITY_TRACE_ID": "2af91dd0-68e4-4721-bbab-4fd40139dc4b",
        "AVAILITY_SESSION_ID": "-3276736574235212345",
        "PAYER_TRACE_ID": "-6763811461698609176"
    },
    "errors": [],
    "request": {
        "offset": 0,
        "limit": 50,
        "payerId": "CSP01",
        "fromDate": "2023-01-01",
        "toDate": "2023-01-01",
        "patientMemberId": "E7E03022034A",
        "patientLastName": "Last",
        "patientFirstName": "First",
        "patientBirthDate": "2000-01-01",
        "patientSameAsSubscriber": false,
        "providerLastName": "last",
        "providerNpi": "1003868548",
        "subscriberLastName": "sublast",
        "subscriberMemberId": "E7E03022034A",
        "requestType": "HIPAA_276"
    }
}

valueAdds277

Return an ASC X12N 277 response combined with value-added information from the health plan merged into a single JSON API response. You must run an initial searchBy276 request before making a valueAdds277 request.

Endpoints


valueAdds277 endpoints
	Path	Function
1	POST/clmsmgmt/claim-status/claim-status/v1/status/valueAdds277	Request value-added information for a previously received 277 response. You must successfully make a searchBy276 request before making the POST/valueAdds277 request.
2	GET/clmsmgmt/claim-status/claim-status/v1/status/valueAdds277?id={id}	Replace {id} with the response ID returned in the URL of the POST request to "poll" whether the API has received the complete information from the payer. `

Parameters


POST/valueAdds277 parameters
Parameter	Type	Definition
filter	Body object (required)	Narrow the results of your search using the search filter body object. See the POST/valueAdds277 filter request body for possible fields and definitions.
Accept	Header string (optional)	Allows you to specify `application/json` or `application/xml`
Content-Type	Header string (optional)	Allows you to specify `application/json` or `application/xml`


POST/valueAdds277 filter fields and definitions
Parameter	Type	Definition
parentTransactionId	Query string (required)	ID that was returned from the POST for the previous searchBy276 request or found as the AVAILITY_TRACE_ID in the response.
claimNumber	Query string (required)	The identifier of the originally submitted claim assigned by the health plan.
claimIndex	Integer (required)	The zero-based index for where the claim was returned in the parent transaction.
payerId	Query string (required)	The Availity payer ID targeted in the search. Note: This value must match the payer ID in the searchBy276 request.
traceId	Query string (optional)	A unique identifier from the requester's system that can be linked to the AVAILITY_TRACE_ID. It identifies a specific request and can be used for research purposes.
requestType	Query string (optional)	Identifies the type of request being made, allowing the service to perform any type-specific validation or logic that may be required. The only option for valueAdds277 is VALUE_ADD_277
providerTaxId	Query string (optional)	The provider's tax ID number.
processedDate	Query string (date) (optional)	The date the claim was processed.


GET/valueAdds277 parameters
Parameter	Type	Definition
id	Query 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`

Sample requests and responses

1. POST/valueAdds277

Request:

curl --location --request POST 'https://qa-apps.availity.com/ms/api/availity/internal/clmsmgmt/claim-status/claim-status/internal/v1/status/valueAdds277' \
--header 'Content-Type: application/json' \
--data-raw '{
    "parentTransactionId": "2af91dd0-68e4-4721-bbab-4fd40139dc4b",
    "payerId": "CSP01",
    "claimNumber": "20210AK6672",
    "claimIndex": "0",
    "providerNpi": "1003868548",
    "requestType": "VALUE_ADDS_277"
}'

Response:

{
    "id": "179f76b0-159e-41d7-9b2c-6a900ebfc11f"
}

2. GET/valueAdds277

Request:

Use the Response ID from your POST response to perform the GET request:

curl --location --request GET 'https://qa-apps.availity.com/
ms/api/availity/internal/clmsmgmt/claim-status/claim-status/internal/
v1/status/valueAdds277?id=179f76b0-159e-41d7-9b2c-6a900ebfc11f'

Response:

After Availity processes the request, the resource returns the value-added 277 information:

{
    "completeCode": 4,
    "traceIds": {
        "AVAILITY_TRACE_ID": "2af91dd0-68e4-4721-bbab-4fd40139dc4b",
        "AVAILITY_SESSION_ID": "-3276736574235212345",
        "PAYER_TRACE_ID": "-6763811461698609176",
        "VALUE_ADD_AVAILITY_TRACE_ID": "179f76b0-159e-41d7-9b2c-6a900ebfc11f"
    },
    "claim": {
        "type": "DENTAL",
        "customerId": "1194",
        "claimNumber": "20210AK6672",
        "status": "PENDING",
        "statusCode": "45",
        "statusCodeDescription": "Processed according to contract provisions Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
        "categoryCode": "F1",
        "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
        "receivedDate": "2022-08-30",
        "exchangeDate": "2021-01-25T11:23:20Z",
        "effectiveDate": "2020-08-10T00:00:00Z",
        "finalizedDate": "2020-08-10",
        "fromDate": "2020-07-25",
        "toDate": "2020-07-25",
        "amounts": {
            "INELIGIBLE": {
                "value": "0.00"
            },
            "COPAY": {
                "value": "10.00"
            },
            "PATIENT_RESPONSIBILITY": {
                "value": "0.00"
            },
            "COINSURANCE": {
                "value": "10.00"
            },
            "ALLOWED": {
                "value": "0.00"
            },
            "BILLED": {
                "value": "3700"
            },
            "DISCOUNT": {
                "value": "0.00"
            },
            "DEDUCTIBLE": {
                "value": "10.00"
            },
            "INSURANCE_TOTAL_PAID": {
                "value": "211.73"
            }
        },
        "payer": {
            "id": "050",
            "name": "ANTHEM BLUE CROSS BLUE SHIELD"
        },
        "submitter": {
            "lastName": "AVAILITY, LLC",
            "id": "680594620"
        },
        "providers": [
            {
                "lastName": "AVAILITY, LLC",
                "firstName": "Provider",
                "middleName": "GP",
                "payerAssignedId": "PAId1",
                "taxId": "789345127",
                "npi": "1003868548"
            },
            {
                "type": "BILLING",
                "taxId": "789345126",
                "npi": "1003868540",
                "address": {}
            }
        ],
        "subscriber": {
            "lastName": "LEEJONES",
            "firstName": "DARREN",
            "memberId": "E7E508T98764"
        },
        "patient": {
            "lastName": "LEEJONES",
            "firstName": "DARREN",
            "birthDate": "1984-03-04",
            "accountNumber": "UNKNOWN",
            "memberId": "E7E508T98764",
            "subscriberRelationship": "SELF",
            "subscriberRelationshipCode": "18"
        },
        "controlNumber": "20210AK6672",
        "userId": "aka00000000001",
        "remittanceInfo": [
            {
                "checkNumber": "3101312484",
                "checkDate": "2020-08-14"
            },
            {
                "checkDate": "1999-07-11"
            }
        ],
        "statusDetails": [
            {
                "statusCode": "107",
                "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
                "categoryCode": "F1",
                "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
                "effectiveDate": "2020-08-10T00:00:00Z"
            }
        ],
        "serviceLines": [
            {
                "lineNumber": 1,
                "procedureQualifierCode": "HC",
                "procedureQualifierCodeDescription": "Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes",
                "procedureCode": "A0428",
                "procedureCodeDescription": "XYZ Codes description",
                "modifiers": {
                    "HH": "Mental hlth/substance abs pr"
                },
                "amounts": {
                    "INELIGIBLE": {
                        "value": "250.00"
                    },
                    "COPAY": {
                        "value": "0.00"
                    },
                    "PATIENT_RESPONSIBILITY": {
                        "value": "0.00"
                    },
                    "COINSURANCE": {
                        "value": "0.00"
                    },
                    "ALLOWED": {
                        "value": "0.00"
                    },
                    "BILLED": {
                        "detail": "USD",
                        "value": "3700"
                    },
                    "DISCOUNT": {
                        "value": "0.00"
                    },
                    "DEDUCTIBLE": {
                        "value": "0.00"
                    },
                    "INSURANCE_TOTAL_PAID": {
                        "detail": "USD",
                        "value": "211.73"
                    }
                },
                "quantity": "1",
                "controlNumber": "1",
                "fromDate": "2020-07-25",
                "toDate": "2020-07-25",
                "statusDetails": [
                    {
                        "statusCode": "107",
                        "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
                        "categoryCode": "F1",
                        "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
                        "effectiveDate": "2020-08-10T00:00:00Z"
                    }
                ],
                "status": "PENDING",
                "statusCode": "107",
                "statusCodeDescription": "Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)",
                "categoryCode": "F1",
                "categoryCodeDescription": "Finalized/Payment  The Claim/Line has been paid",
                "effectiveDate": "2022-08-31T00:00:00Z",
                "additionalProperties": {
                    "approvedLengthOfStay": "5"
                }
            }
        ],
        "eligibleForValueAdds": true,
        "summary": false
    },
    "errors": [],
    "request": {
        "parentTransactionId": "2af91dd0-68e4-4721-bbab-4fd40139dc4b",
        "payerId": "CSP01",
        "claimNumber": "20210AK6672",
        "requestType": "VALUE_ADDS_277"
    }
}

summarySearch

Search by service date, member ID, claim history, and/or check number to return high-level information about one or multiple claims.

Note: You must set up provider tax identification numbers (TINs) and National Provider Identifiers (NPIs) through the Availity organization you registered on Availity for Developers.

Endpoints


summarySearch endpoints
	Path	Function
1	POST/clmsmgmt/claim-status/claim-status/v1/status/summarySearch	Search for a summary of claim status information in real time.
2	GET/clmsmgmt/claim-status/claim-status/v1/status/ summarySearch/{id}	Use the response ID returned in the URL of the POST request to "poll" whether the API has received the complete information from the payer.

Parameters


POST/summarySearch parameters
Parameter	Type	Definition
filter	Body object (required)	Narrow the results of your search using the search filter body object. See the POST/summarySearch filter request body for possible 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`


POST/summarySearch filter fields and definitions
Parameter	Type	Definition
offset	Integer (optional)	The zero-based starting index in the collection of the first item to return.
limit	Integer (optional)	The maximum number of collection items to return for a single request. Minimum = 1, maximum = 50.
payerId	Query string (required)	The targeted health plan's Availity payer ID.
requestType	Query string (required)	Identifies the type of request being made. For a Summary Search, accepted values are SERVICE_DATE and MEMBER_ID.
traceId	Query string (optional)	An Availity-specific identifier that links to the Availity transaction.
memberId	Query string (optional)	Member ID of the patient or subscriber, depending on search type.
memberBirthDate	Query string (date) (optional)	The member's birthdate.
groupNumber	Query string (optional)	The health plan policy group number.
fromDate	Query string (date) (optional)	The service from (beginning) date.
toDate	Query string (date) (optional)	The service to (end) date.
processedDate	Query string (date) (optional)	The date the transaction was processed.
providerNpi	Query string (optional)	The provider's National Provider ID.
providerTaxId	Query string (optional)	The provider's tax ID number.
requestedStatus	Query string (optional)	Allows provider to search by status group. These groups are as follows: `ALL` (returns all statuses, including `ACKNOWLEDGED`) `ALL_PENDING` (returns `ACTION_REQUIRED` and `PENDING` statuses) `ALL_FINALIZED` (returns `ADJUSTED`, `CAPITATED`, `DENIED`, `FINALIZED`, and `PAID` statuses) `ALL_ERROR_REJECTED` (returns `ERROR`, `REJECTED`, and `RETURNED_TO_ PROVIDER` statuses)
checkNumber	Query string (optional)	Check or EFT number.
patientAccountNumber	Query string (optional)	Number for the patient's account.
payerAssignedProviderId	Query string (optional)	The provider's ID assigned by the payer.


GET/summarySearch parameters
Parameter	Type	Definition
id	Query 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`

Sample requests and responses

POST/summarySearch

Request:

curl --location --request POST 'https://qa-apps.availity.com/ms/api/availity/internal/clmsmgmt/claim-status/claim-status/internal/v1/status/summarySearch' \
--header 'Content-Type: application/json' \
--data-raw '{
    "payerId": "CSP01",
    "fromDate": "2023-01-01",
    "providerNpi": "1234567890",
    "requestedStatus": "ALL",
    "toDate": "2023-01-01",
    "memberId": "5832330507714560",
    "groupNumber": "123456",
    "requestType": "MEMBER_ID"
}'

Response:

{
    "id": "ef5c581b-234e-41cc-b0be-d00bf965d4f4"
}

2. GET/summarySearch

Request:

Use the Response ID from your POST response to perform the GET request:

curl --location --request GET 'https://qa-apps.availity.com/ms/
api/availity/internal/clmsmgmt/claim-status/claim-status/internal/v1/status/
summarySearch?id=ef5c581b-234e-41cc-b0be-d00bf965d4f4'

Response:

After Availity processes the request, the resource returns the summary information:

{
    "items": [
        {
            "claimNumber": "EVJKAJ78G00",
            "status": "RETURNED_TO_PROVIDER",
            "exchangeDate": "2023-10-11T17:22:04Z",
            "fromDate": "2007-01-01",
            "toDate": "2008-01-01",
            "amounts": {
                "BILLED": {
                    "value": "11000.00"
                }
            },
            "patient": {
                "lastName": "Lazzerini",
                "firstName": "Mollie",
                "middleName": "R",
                "suffix": "MR",
                "birthDate": "2009-01-01",
                "gender": "U",
                "accountNumber": "30039697289884",
                "memberId": "268088081645568",
                "subscriberRelationship": "PARENT",
                "subscriberRelationshipCode": "32"
            },
            "remittanceInfo": [
                {
                    "checkAmount": "55.00",
                    "checkNumber": "44207199433523",
                    "checkDate": "2011-01-01"
                }
            ],
            "summary": true
        },

        {
            "claimNumber": "DVGGHK85544",
            "status": "PAID",
            "exchangeDate": "2023-10-11T17:22:04Z",
            "fromDate": "2007-03-25",
            "toDate": "2007-03-25",
            "amounts": {
                "BILLED": {
                    "value": "11000.00"
                }
            },
            "patient": {
                "lastName": "Lazzerini",
                "firstName": "Mollie",
                "middleName": "R",
                "suffix": "MR",
                "birthDate": "2009-01-01",
                "gender": "U",
                "accountNumber": "30039697289884",
                "memberId": "268088081645568",
                "subscriberRelationship": "PARENT",
                "subscriberRelationshipCode": "32"
            },
            "remittanceInfo": [

                {
                    "checkAmount": "55.00",
                    "checkNumber": "44207199433523",
                    "checkDate": "2011-01-01"
                }
            ],
            "summary": true
        }
    ],
    "offset": 0,
    "limit": 50,
    "count": 2,
    "totalCount": 2,
    "completeCode": 4,
    "traceIds": {

        "AVAILITY_TRACE_ID": "ef5c581b-234e-41cc-b0be-d00bf965d4f4"

    },

    "errors": [],

    "request": {
        "offset": 0,
        "limit": 50,
        "payerId": "CSP01",
        "requestType": "MEMBER_ID",
        "memberId": "5832330507714560",
        "providerNpi": "1234567890",
        "fromDate": "2023-01-01",
        "toDate": "2023-01-01",
        "groupNumber": "123456",
        "requestedStatus": "ALL"

    }

}

detailSearch

Search by provider tax ID number/NPI and claim number to return detailed information about a single claim. You can make the detailSearch request indepedently or after running a summarySearch request.

Note: You must set up provider tax identification numbers (TINs) and National Provider Identifiers (NPIs) through the Availity organization you registered on Availity for Developers.

Endpoints


detailSearch endpoints
	Path	Function
1	POST/clmsmgmt/claim-status/claim-status/v1/status/detailSearch	Perform a detailed search for a claim status.
2	GET/clmsmgmt/claim-status/claim-status/v1/status/detailSearch/{id}	Use the response ID returned in the URL of the POST request to "poll" whether the API has received the complete information from the payer.

Parameters


POST/detailSearch parameters
Parameter	Type	Definition
filter	Body object (required)	Narrow the results of your search using the search filter body object. See the POST/detailSearch filter request body for possible 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`


POST/detailSearch filters and definitions
Field	Type	Definition
parentTransactionId	Query string (optional)	Identification number that was returned from the POST request for a previously run summarySearch, or found as the AVAILITY_TRACE_ID in the summarySearch response. Note: You are not required to make a summarySearch request before making a detailSearch request.
payerId	Query string (required)	The Availity payer ID of the health plan targeted in your search.
requestType	Query string (required)	Identifies the type of request being made to allow the service to perform type-specific validation or logic that may be required. The only accepted value for detailSearch is CLAIM_NUMBER.
traceId	Query string (optional)	A unique identifier from the requester's system that can be linked to the AVAILITY_TRACE_ID. It identifies a specific request and can be used for research purposes.
claimNumber	Query string (required)	The health plan's identifier for the originally submitted claim.
processedDate	Query string (date-time) (optional)	The date the claim was processed.
providerNpi	Query string (optional)	The provider's National Provider Identifier.
providerTaxId	Query string (optional)	The provider's tax ID number.
fromDate	Query string (date-time) (optional)	The service from (beginning) date.
toDate	Query string (date-time) (optional)	The service to (end) date.


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

Sample requests and responses

POST/detailSearch

Request:

curl --location --request POST 'https://qa-apps.availity.com/ms/api/availity/internal/clmsmgmt/claim-status/claim-status/internal/v1/status/detailSearch' \
--header 'Content-Type: application/json' \
--data-raw '{
"payerId": "CSP01",
"requestType": "CLAIM_NUMBER",
"providerNpi": "1234567890",
"providerTaxId": "123456789",
"claimNumber": "EVJKAJ78G00",
"claimIndex": "0",
"fromDate": "2023-01-01",
"toDate": "2023-01-01",
"parentTransactionID": "ef5c581b-234e-41cc-b0be-d00bf965d4f4"

}'

Response:

{
    "id": "3925be8f-ef1b-4010-8412-9da2f39d9ac0"
}

2. GET/detailSearch

Request:

Use the Response ID from your POST response to perform the GET request:

curl --location --request GET 'https://qa-apps.availity.com/
ms/api/availity/internal/clmsmgmt/claim-status/claim-status/internal/
v1/status/detailSearch?id=3925be8f-ef1b-4010-8412-9da2f39d9ac0'

Response:

After Availity processes the request, the resource returns the detail information:

{
    "completeCode": 4,
    "traceIds": {
        "AVAILITY_TRACE_ID": "3925be8f-ef1b-4010-8412-9da2f39d9ac0"
    },
    "claim": {
        "type": "DENTAL",
        "customerId": "1194",
        "claimNumber": "EVJKAJ78G00",
        "status": "RETURNED_TO_PROVIDER",
        "statusCode": "100",
        "statusCodeDescription": "Dsc-100",
        "categoryCode": "F1",
        "categoryCodeDescription": "Dsc-F1",
        "customCategoryCode": "F1.1",
        "customCategoryCodeDescription": "Dsc-F1.1",
        "receivedDate": "2002-01-01",
        "effectiveDate": "2005-01-01T00:00:00Z",

        "finalizedDate": "2006-01-01",
        "fromDate": "2007-01-01",
        "toDate": "2008-01-01",
        "amounts": {
            "PATIENT_RESPONSIBILITY": {
                "value": "22.0"
            },
            "BILLED": {
                "value": "3.0"
            },
            "PATIENT_PAID": {
                "value": "21.0"
            },
            "DISCOUNT": {
                "value": "6.5"
            },
            "COINSURANCE": {
                "value": "4.0"
            },
            "INELIGIBLE": {
                "value": "8.0"
            },
            "DEDUCTIBLE": {
                "value": "6.0"
            },
            "COPAY": {
                "value": "5.0"
            },
            "INSURANCE_TOTAL_PAID": {
                "value": "11.0"
            },
            "ADJUSTMENT": {
                "value": "1.0"
            },
            "ALLOWED": {
                "value": "2.0"
            }
        },
        "payer": {
            "id": "CSP01",
            "name": "HEALTHPLAN0",
            "contact": {
                "lastName": "Smart",
                "firstName": "Joe",
                "middleName": "Z",
                "suffix": "DRR"
            },
            "phone": "8006245861",
            "extension": "123",
            "fax": "9008975861",
            "email": "JohnSmith@HealthPlan0.com",
            "address": {
                "address1": "123 Sunny Lane",
                "address2": "Suite 0",
                "city": "France",
                "state": "IN",
                "zip": "22245",
                "zipPlus4": "0000"
            }
        },
        "providers": [
            {
                "lastName": "Generic",
                "firstName": "Provider",
                "middleName": "GP",
                "payerAssignedId": "PAId1",
                "taxId": "789345127",
                "npi": "1003868540"
            },
            {
                "lastName": "Day",
                "firstName": "Polly",
                "middleName": "A",
                "suffix": "MS",
                "type": "BILLING",
                "payerAssignedId": "487593506504704",
                "taxId": "123456789",
                "npi": "1234567890",
            },
            {
                "lastName": "Johnson",
                "firstName": "Fred",
                "middleName": "Z",
                "suffix": "MR",
                "type": "RENDERING",
                "payerAssignedId": "487593506504704",
                "taxId": "111111119",
                "npi": "222222228",
            }
        ],
        "subscriber": {
            "lastName": "Burgess",
            "firstName": "Russell",
            "middleName": "D",
            "suffix": "MRS",
            "memberId": "5832330507714560",
            "groupNumber": "4126016859537408",
            "taxId": "867758125"
        },
        "patient": {
            "lastName": "Lazzerini",
            "firstName": "Mollie",
            "middleName": "R",
            "suffix": "MR",
            "birthDate": "2009-01-01",
            "gender": "U",
            "accountNumber": "30039697289884",
            "memberId": "268088081645568",
            "subscriberRelationship": "PARENT",
            "subscriberRelationshipCode": "32"
        },
        "lineOfBusiness": "55 - HealthPlan3",
        "billTypeIdentifier": "111",
        "billTypeIdentifierDescription": "Dsc-111",
        "drgCode": "768",
        "drgVersion": "39",
        "drgWeight": "2.0",
        "controlNumber": "3075730734841856",
        "userId": "JohnSnow1",
        "claimGenKey": "002",
        "facilityTypeCode": "11",
        "facilityTypeCodeDescription": "Dsc-11",
        "frequencyTypeCode": "1",
        "frequencyTypeCodeDescription": "Dsc-1",
        "remittanceInfo": [
            {
                "id": "856128994934784",
                "remittanceDate": "2010-01-01",
                "payeeName": "Theodore Gibson",
                "payeeType": "INSTITUTIONAL",
                "payeeTaxId": "863192687",
                "payeeNPI": "1123456789",
                "payeeId": "6364516023533568",
                "checkAmount": "55.00",
                "checkNumber": "44207199433523",
                "checkDate": "2011-01-01",
                "checkStatus": "CASHED",
                "checkCashedDate": "2012-01-01T00:00:00Z",
                "deliveryInfo": {
                    "address1": "678 Barber St",
                    "address2": "None",
                    "city": "Geneva",
                    "state": "FL",
                    "zip": "23567",
                    "zipPlus4": "2346"
                }
            }
        ],
        "statusDetails": [
            {
                "statusCode": "200",
                "customStatusCode": "200.1",
                "categoryCode": "F2",
                "customCategoryCode": "F2.1",
                "entityCode": "E2",
                "effectiveDate": "2013-01-01T00:00:00Z"
            }
        ],
        "serviceLines": [
            {
                "lineNumber": 1,
                "procedureQualifierCode": "AA",
                "procedureQualifierCodeDescription": "Dsc-AA",
                "procedureCode": "AAAAA",
                "procedureCodeDescription": "Dsc-AAAAA",
                "revenueCode": "111",
                "revenueCodeDescription": "Dsc-111",
                "modifiers": {
                    "primary": "HH"
                },
                "amounts": {
                    "PATIENT_RESPONSIBILITY": {
                        "value": "222.0"
                    },
                    "BILLED": {
                        "value": "23.0"
                    },
                    "PATIENT_PAID": {
                        "value": "221.0"         
                    },
                    "DISCOUNT": {
                        "value": "26.5"
                    },
                    "COINSURANCE": {
                        "value": "24.0"
                    },
                    "INELIGIBLE": {
                        "value": "28.0"
                    },
                    "DEDUCTIBLE": {
                        "value": "26.0"
                    },
                    "COPAY": {
                        "value": "25.0"
                    },
                    "INSURANCE_TOTAL_PAID": {
                        "value": "211.0"
                    },
                    "ADJUSTMENT": {
                        "value": "21.0"
                    },
                    "ALLOWED": {
                        "value": "22.0"
                    }
                },
                "serviceCode": "11111",
                "quantity": "2",
                "controlNumber": "3869389619200000",
                "fromDate": "2015-01-01",
                "toDate": "2016-01-01",
                "statusDetails": [
                    {
                        "statusCode": "300",
                        "statusCodeDescription": "Dsc-300",
                        "customStatusCode": "300.1",

                        "customStatusCodeDescription": "Dsc-300.1",
                        "categoryCode": "F3",
                        "categoryCodeDescription": "Dsc-F3",
                        "customCategoryCode": "F3.1",
                        "customCategoryCodeDescription": "Dsc-F3.1",
                        "entityCode": "E1",
                        "entityCodeDescription": "Dsc-E1",
                        "effectiveDate": "2022-01-01T00:00:00Z"
                    }
                ],
                "status": "ACTION_REQUIRED",
                "statusCode": "400",
                "statusCodeDescription": "Dsc-400",
                "effectiveDate": "2021-01-01T00:00:00Z",
                "additionalProperties": {
                    "toothNumber": "1",
                    "approvedLengthOfStay": "5",
                    "writeOffAmt": "50.00",
                    "notCoveredAmt": "100.00"
                }
            },
            {
                "lineNumber": 2,
                "amounts": {
                    "INSURANCE_TOTAL_PAID": {
                        "value": "111.0"
                    },
                    "BILLED": {
                        "value": "13.0"
                    }
                },
                "serviceCode": "33333",
                "quantity": "10",
                "controlNumber": "3869389619200000",
                "fromDate": "2017-01-01",
                "toDate": "2018-01-01"
            }
        ],
        "additionalProperties": {
            "estimatesFlag": "Y",
            "toothNumber": "1",
            "approvedLengthOfStay": "5",
            "writeOffAmt": "50.00",
            "notCoveredAmt": "100.00"
        },
        "adjusted": false,
        "eligibleForAttachment": true,
        "requiresAttachment": false,
        "eligibleForCorrection": true,
        "eligibleForMessaging": true,
        "eligibleForAppeal": true,
        "eligibleForValueAdds": true,
        "summary": true,
        "eligibleForChat": true,
        "eligibleForOverpayment": true
    },
    "request": {
        "parentTransactionId": "ef5c581b-234e-41cc-b0be-d00bf965d4f4",
        "payerId": "CSP01",
        "requestType": "CLAIM_NUMBER",
        "claimNumber": "EVJKAJ78G00",
        "claimIndex": 0,
        "providerNpi": "1234567890",
        "providerTaxId": "123456789",
        "fromDate": "2023-01-01",
        "toDate": "2023-01-01"
    }
}

Response definitions


Enhanced Claim Status response definitions: Primary objects and fields
Field	Type	Definition
offset	String (integer)	The zero-based starting index in the collection of the first item to return.
limit	String (integer)	The maximum number of collection items returned for a single request. Minimum = 1, maximum = 50.
count	String (integer)	The number of items returned.
totalCount	String (integer)	The total number of items available that match the parameters specified.
id	String	Transaction ID created for this request.
errors	Array	Array detailing errors that occurred during the search. Fields include `code`, `level` (values: `ERROR` and `WARNING`), `developerMessage`, and `userMessage`.
request	Object	Object detailing the request parameters sent for the search.
items	Array	Array that returns the claim object(s) with information about the claim status. Refer to the claim table for field definitions within the claim object.
traceIds	Object	Object providing a map of reference IDs assigned by Availity and the health plan to uniquely identify this claim. Possible fields include: `SUBMITTER_TRACE_ID` `AVAILITY_TRACE_ID` `PAYER_TRACE_ID` `FAST_PATH_ID` `AVAILITY_LEGACY_TRACE_ID` `VALUE_ADD_AVAILITY_TRACE_ID` `VALUE_ADD_AVAILITY_LEGACY_ TRACE_ID` `VALUE_ADD_SUBMITTER_TRACE_ID`


Enhanced Claim Status response definitions: Fields within `claim`
Field	Type	Definition
claimNumber	String	The health plan-assigned identifier for the claim.
type	String	An indicator of the type of claim. Values: INSTITUTIONAL, PROFESSIONAL, DENTAL.
customerId	String	The Availity ID of the organization that submitted the claim status. Availity may ask for this during support calls.
status	String	The current status of the claim. Values: ACKNOWLEDGED ACTION_REQUIRED ADJUSTED CAPITATED DENIED ERROR FINALIZED PAID PENDING REJECTED RETURNED_TO_PROVIDER
comment	String	Payer-provided information about the claim.
statusCode	String	The code for the claim's status. Refer to X12 External Code Source 508: Claim Status Codes.
statusCodeDescription	String	Description of the status associated with the claim.
customStatusCode	String	Proprietary or custom identifier for the status associated with the claim or service line.
customStatusCodeDescription	String	Description of the proprietary or custom status code associated with the claim or service line.
categoryCode	String	Code for the claim status's category. Refer to X12 External Code Source 507: Claim Status Category Codes.
categoryCodeDescription	String	Description of the claim status's category.
customCategoryCode	String	Proprietary or custom code that specifies the category of the claim status.
customCategoryCodeDescription	String	Description of the proprietary or custom category of the claim status.
submittedDate	String (date)	Date the provider submitted the claim for processing.
receivedDate	String (date)	Date the claim was received by the payer.
exchangeDate	String (date-time)	The date/time Availity received the claim status data.
promptPayPenaltyDate	String (date)	The date after which the prompt pay penalty takes effect.
effectiveDate	String (date)	Date the claim status was last updated.
finalizedDate	String (date)	The date the claim was or will be finalized.
fromDate	String (date)	Service from date.
toDate	String (date)	Service to date.
lineOfBusiness	String	The line of business associated with the claim.
billTypeIdentifier	String	Identifier linked to the billing type.
billTypeIdentifierDescription	String	Description of the billing type identifier.
drgCode	String	The claim's Diagnosis Related Grouping (DRG) code.
drgVersion	String	The version of the DRG code used.
drgWeight	String	The weighting factor assigned for the DRG code.
controlNumber	String	Unique number assigned by the sender to each claim item reported.
userId	String	Identifier used to reference the user.
claimGenKey	String	Identifier linked to the generation of the claim.
facilityTypeCode	String	Code identifying the type of facility where services were or may be performed for institutional claims. Code source: First and second positions of Uniform Bill Type Code for Institutional Services.
facilityTypeCodeDescription	String	Description of the facility type.
frequencyTypeCode	String	Code specifying the frequency of the claim. Refer to X12 External Code Source 235: Claim Frequency Type Code.
frequencyTypeCodeDescription	String	Description of the frequency type.
otherIds	Object	Object detailing non-standard identifiers associated with the claim.
adjusted	Boolean	Indicates whether the claim has been adjusted. Values: TRUE/FALSE.
summary	Boolean	Indicates whether this claim object is a summary and does not include all details. Values: TRUE/FALSE.
remarks	Array	Array providing additional remarks about the claim. Includes fields for code (source: X12 External Code Source 411), reason, and additional properties.
customRemarks	Array	Array providing custom or proprietary remarks about the claim. Includes fields for code, reason, and additional properties.
amounts	Object	Object providing a map of amount types and amounts related to the claim at the claim level. Refer to the claim.amounts table for fields and field definitions.
payer	Object	Object providing contact and identifying information about the payer. Refer to the claim.payer table for fields and definitions.
otherInsurances	Array	Array providing information about insurance other than the primary payer involved in the claim. Includes amounts and additionalProperties objects.
submitter	Object	Object providing information about the submitter of the claim. Refer to the claim.submitter table for fields and definitions.
providers	Object	Object providing contact and identifying information about the provider(s) involved in the claim. Refer to the claim.providers table for fields and definitions.
subscriber	Object	Object providing contact and identifying information about the subscriber of the health plan. Refer to the claim.subscriber table for fields and definitions.
patient	Object	Object providing contact and identifying information about the patient involved in the claim. Refer to the claim.patient table for fields and definitions.
remittanceInfo	Array	Array providing information about remittance of the claim. Refer to the claim.remittanceInfo table for field definitions.
statusDetails	Array	Array providing additional status information reported for the original claim at the claim level. Refer to the claim.statusDetails table for field definitions.
serviceLines	Array	Array providing service line information from the originally submitted/processed claim. Refer to the claim.serviceLines table for field definitions.
additionalProperties	Object	Object providing optional custom properties regarding the claim. The additionalProperties sections are for custom fields and are reserved for cases when the standard options are not suitable for a trading partner. They are not required for implementing Enhanced Claim Status. Fields include key (string) and value (object).


Enhanced Claim Status response definitions: Fields within `claim.amounts`
Field	Type	Definition
ADJUSTMENT	String	Amount insurer has reduced the billed amount to the contractually allowed amount
ALLOWED	String	Contractual amount a health plan will pay for service
BILLED	String	The total claim amount billed by the provider.
COINSURANCE	String	Cost that the patient is responsible for after the deductible has been met (typically a percentage).
COPAY	String	Amount the patient is responsible for for certain medical treatments and medication.
DEDUCTIBLE	String	Amount a patient must pay for covered healthcare services before insurance starts to pay.
HEALTH_CARE_ACCOUNT	String	Amount paid from an HSA or FSA.
INELIGIBLE	String	Amount denied by health plan.
INSURANCE_CURRENT_PAID	String	Amount insurance paid in this round of processing. Does not include copay, deductible, coinsurance.
INSURANCE_PRIOR_PAID	String	Amount of all prior payments. Does not include copay, deductible, coinsurance.
INSURANCE_TOTAL_PAID	String	Total amount of all payments. Does not include copay, deductible, coinsurance.
INTEREST_OR_PENALTY	String	Any additional amount incurred over time due to lack of prompt payment.
MEDICARE_PAID	String	Amount Medicare has paid towards the claim.
OTHER_INSURANCE_CARRIER	String	Used for coordination of benefits.
OTHER_INSURANCE_ COINSURANCE	String	Used for coordination of benefits.
OTHER_INSURANCE _COINSURANCE_ DEDUCTIBLE	String	Used for coordination of benefits.
OTHER_INSURANCE_ DEDUCTIBLE	String	Used for coordination of benefits.
OTHER_INSURANCE_PAID	String	Used for coordination of benefits.
OUT_OF_NETWORK _COINSURANCE	String	Used for coordination of benefits.
OUT_OF_NETWORK _DEDUCTIBLE	String	Used for coordination of benefits.
PATIENT_PAID	String	Amount patient has paid out of pocket.
PATIENT _RESPONSIBILITY	String	Amount patient is responsible for paying out of pocket. Does not include copay.
PRIOR_NOTIFICATION _COINSURANCE	String	Coinsurance amount notified in previous round of claim processing.
PRIOR_NOTIFICATION _DEDUCTIBLE	String	Deductible amount notified in previous round of claim processing.
PRIOR_NOTIFICATION _INSURANCE_PAID	String	Insurance paid amount notified in previous round of claim processing
POOL_LIABILITY	String	Amount risk pool is responsible for (typically for a defined set of services).
SEQUESTRATION	String	Across-the-board Medicare cuts controlled by the Budget Control Act.
THIRD_PARTY _ADMINISTRATOR	String	Administrator if the insurance carrier outsources some of the claims processing.
additionalProperties	Object	Object providing optional custom properties regarding the amounts. The additionalProperties sections are for custom fields and are reserved for cases when the standard options are not suitable for a trading partner. They are not required for implementing Enhanced Claim Status. Fields include key (string) and value (object).


Enhanced Claim Status response definitions: Fields within `claim.payer`

id	String	The payer identifier.
name	String	The payer's name.


Enhanced Claim Status response definitions: Fields within `claim.submitter`

id	String	The submitter's identifier.
lastName	String	The submitter's last name.


Enhanced Claim Status response definitions: Fields within `claim.providers`

id	String	The provider's identifier.
lastName	String	The provider's last name.
npi	String	The provider's National Provider Identifier.
type	String	The provider's type.


Enhanced Claim Status response definitions: Fields within `claim.subscriber`

lastName	String	The health plan subscriber's last name.
firstName	String	The health plan subscriber's first name.
middleName	String	The health plan subscriber's middle name.
suffix	String	The health plan subscriber's suffix.
memberId	String	The health plan subscriber's member ID number.
groupNumber	String	The health plan subscriber's group number.


Enhanced Claim Status response definitions: Fields within `claim.patient`

lastName	String	The patient's last name.
firstName	String	The patient's first name.
middleName	String	The patient's middle name.
suffix	String	The patient's suffix.
birthDate	String	That patient's date of birth.
subscriberRelationship	Boolean	Indicates whether the patient and health plan subscriber are the same person.
subscriberRelationshipCode	String	Code indicating the patient's relationship to the subscriber.
gender	String	The patient's gender.
memberId	String	The patient's member ID number.
accountNumber	String	Number that identifies the patient's health plan account.


Enhanced Claim Status response definitions: Fields within `claim.remittanceInfo`
Field	Type	Definition
id	String	The remittance's identifier.
remittanceDate	String (date)	The date the payment check was issued.
payeeType	String	The type of entity receiving the payment. Values: SUBSCRIBER PROVIDER ALTERNATE INSTITUTIONAL UNKNOWN
payeeName	String	Name of the payee on the remittance information.
payeeTaxId	String	The tax ID of the payee on the remittance information.
payeeNPI	String	The NPI for the payee on the remittance information.
payeeId	String	The identifier for the payee on the remittance information.
checkAmount	String	The amount the check was written for.
checkNumber	String	The check or EFT number.
checkDate	String (date)	The date the check was issued.
checkStatus	String	The check's status.
checkCashedDate	String (date-time)	The date the check was cashed.
deliveryInfo	Object	Object providing address information for the organizational entity, physical location, or individual associated with the check. Definitions for the fields within this object are omitted for brevity
additionalProperties	Object	Object providing optional custom properties regarding the remittance. The additionalProperties sections are for custom fields and are reserved for cases when the standard options are not suitable for a trading partner. They are not required for implementing Enhanced Claim Status. Fields include key (string) and value (object).


Enhanced Claim Status response definitions: Fields within `claim.statusDetails`
Field	Type	Definition
statusCode	String	The code for the claim's status. Refer to X12 External Code Source 508: Claim Status Codes.
statusCodeDescription	String	Describes the claim's code status. Refer to X12 External Code Source 508: Claim Status Codes.
customStatusCode	String	Proprietary or custom code indicating the current claim status.
customStatusCodeDescription	String	Description of the proprietary or custom code indicating the current claim status.
categoryCode	String	Code indicating the category of the associated claim status code. Refer to X12 External Code Source 507: Claim Status Category Codes.
customCategoryCode	String	Proprietary or custom code that specifies the category of the claim status.
customCategoryCodeDescription	String	Description of the proprietary or custom category of the claim status.
entityCode	String	The code identifying the organizational entity, physical location, or individual associated with the claim status. Refer to the X12 276/277 (Healthcare Claim Status Request and Response) TR3 for the full list of codes.
entityCodeDescription	String	Description of the entity associated with the claim status.
effectiveDate	String (date)	The effective date for the status information.
finalizedDate	String (date)	Date the status detail was finalized.
additionalProperties	Object	Object providing optional custom properties regarding the the claim at the claim level. The additionalProperties sections are for custom fields and are reserved for cases when the standard options are not suitable for a trading partner. They are not required for implementing Enhanced Claim Status. Fields include key (string) and value (object).


Enhanced Claim Status response definitions: Fields within `claim.serviceLines`
Field	Type	Definition
lineNumber	Integer	Number identifying the location of the service line.
procedureQualifier	String	Describes the type/source of the procedure code for this service line.
procedureQualifierCode	String	Code identifying the type/source of the procedure or product/service code used for this service line. Refer to the X12 276/277 (Healthcare Claim Status Request and Response) TR3 for the full list of product/service ID qualifier codes.
procedureCode	String	Code for the procedure performed. Refer to the X12 276/277 (Healthcare Claim Status Request and Response) TR3 for code sources.
procedureCodeDescription	String	Description of the code representing the procedure performed.
revenueCode	String	The service line revenue code. Refer to X12 External Code Source 132: NUBC Codes.
revenueCodeDescription	String	The explanation for the revenue code.
diagnosisCodes	Array	Array detailing the codes that represent the diagnosis. Code source: ICD-9-CM.
modifiers	Object	Object providing information about special circumstances related to performing the service.
amounts	Object	Object providing information about amounts involved in the claim. May include the following fields and associated monetary values: COPAY ALLOWED DISCOUNT INSURANCE_PRIOR_PAID INTEREST_OR_PENALTY BILLED ADJUSTMENT PATIENT_RESPONSIBILITY DEDUCTIBLE
remarks	Array	Array providing additional remarks about the claim. Includes fields for code (source: X12 External Code Source 411), reason, and additional properties.
customRemarks	Array	Array providing custom or proprietary remarks about the claim. Includes fields for code, reason, and additional properties.
adjustments	Object	Object providing information about any adjustments made to the claim at the service line level. Refer to the claim.serviceLines.adjustments table for field definitions.
serviceCode	String	An identifier of the product or service reported in this service line.
quantity	String	Number of units involved in the product or service.
controlNumber	String	The service line control number.
fromDate	String (date)	The service from (beginning) date.
toDate	String (date)	The service to (end) date.
statusDetails	Array	An array of status information reported for the original claim at the service line level. Refer to the claim.statusDetails table for field definitions.
status		The current status of the claim. Values: ACKNOWLEDGED ACTION_REQUIRED ADJUSTED CAPITATED DENIED ERROR FINALIZED PAID PENDING REJECTED RETURNED_TO_PROVIDER
statusCode	String	A code indicating the current claim status. Refer to X12 External Code Source 508: Claim Status Codes.
customStatusCode	String	Proprietary or custom code indicating the current claim status.
customStatusCodeDescription	String	Description of the proprietary or custom code indicating the current claim status.
categoryCode	String	Code for the claim status's category. Refer to X12 External Code Source 507: Claim Status Category Codes.
categoryCodeDescription	String	Description of the claim status's category.
customCategoryCode	String	Proprietary or custom code that specifies the category of the claim status.
customCategoryCodeDescription	String	Description of the proprietary or custom category of the claim status.
effectiveDate	String (date-time)	Date the status was last updated.
additionalProperties	Object	Object providing optional custom properties regarding the the claim at the service line level. The additionalProperties sections are for custom fields and are reserved for cases when the standard options are not suitable for a trading partner. They are not required for implementing Enhanced Claim Status. Fields include key (string) and value (object).


Enhanced Claim Status response definitions: Fields within `claim.serviceLines.adjustments`
Field	Type	Definition
contractualObligations	Array	Array of objects providing information about obligations agreed to under contract. Refer to the adjustments details table for definitions.
otherObligations	Array	Array of objects providing information about non-standard obligations. Refer to the adjustments details table for definitions.
payerInitiatedObligations	Array	Array of objects providing information about obligations initiated by the payer on the claim. Refer to the adjustments details table for definitions.
patientResponsibility	Array	Array of objects providing information about obligations that are the patient's responsibility. Refer to the adjustments details table for definitions.


Enhanced Claim Status response definitions: Fields within `claim.serviceLines.adjustments details`
Field	Type	Definition
reasonCode	String	Code that communicates the reason for a payment adjustment. Refer to X12 External Code Source 139: Claim Adjustment Reason Code.
reasonDescription	String	Description of the reason code and for the adjustment in payment.
amount	String	The payment/billed amount that is being adjusted.
quantity	String	The number of adjustments being made.
additionalProperties	Object	Object providing optional custom properties regarding the the adjustments at the service line level. The additionalProperties sections are for custom fields and are reserved for cases when the standard options are not suitable for a trading partner. They are not required for implementing Enhanced Claim Status. Fields include key (string) and value (object).