--- swagger: "2.0" info: x-ibm-name: coverages title: Coverages version: 1.0.0 description: "" schemes: - https basePath: /v1 consumes: - application/json produces: - application/xml - application/json securityDefinitions: oauth2: type: oauth2 description: "" flow: application scopes: hipaa: Realtime - Live HIPAA API tokenUrl: https://api.availity.com/v1/token security: - oauth2: - hipaa x-ibm-configuration: enforced: true testable: true phase: realized paths: /coverages: get: summary: Initiate a new coverage request or view an existing request. operationId: findCoverage produces: - application/json - application/xml parameters: - name: payerId type: string in: query description: The Availity payer id of the member. - name: providerLastName type: string in: query description: The provider's last name. - name: providerFirstName type: string in: query description: The provider's first name. - name: providerType type: string in: query description: The type of provider as required. - name: providerNpi type: string in: query description: The NPI of the requesting provider. - name: providerTaxId type: string in: query description: The tax id of the requesting provider. - name: payerAssignedProviderId type: string in: query description: The payer assigned provider id of the requesting provider. - name: providerSSN type: string in: query description: The social security number of the requesting provider. - name: providerPIN type: string in: query description: The social security number of the requesting provider. - name: providerCity type: string in: query description: The city of the requesting provider. - name: providerState type: string in: query description: The two character state code of the requesting provider. - name: providerZipCode type: string in: query description: The ZIP code of the requesting provider. - name: providerSpecialty type: string in: query description: The specialty code the requesting provider. - name: placeOfService type: string in: query description: The place of service. - name: submitterId type: string in: query description: Your payer assigned submitter id. - name: asOfDate type: string format: date-time in: query description: The coverage as of date. - name: toDate type: string format: date-time in: query description: The coverage to date. - name: cardIssueDate type: string format: date-time in: query description: The issue date of the card. - name: serviceType type: string in: query description: The service type(s) you are looking for. - name: procedureCode type: string in: query description: The procedure code(s) you are looking for. - name: memberId type: string in: query description: The member id of the patient or subscriber. - name: patientSSN type: string in: query description: The Social Security Number of the patient or subscriber. - name: medicaidId type: string in: query description: The medicaid id of the patient or subscriber. - name: patientLastName type: string in: query description: The patient's last name. - name: patientFirstName type: string in: query description: The patient's first name. - name: patientMiddleName type: string in: query description: The patient's middle name. - name: patientSuffix type: string in: query description: The patient's suffix. - name: patientBirthDate type: string format: date-time in: query description: The patient's birth date. - name: patientGender type: string in: query description: The patient's gender. - name: patientState type: string in: query description: The subscriber's patient of residence. - name: groupNumber type: string in: query description: The patient's group number. - name: subscriberRelationship type: string in: query description: The patient's relationship to the subscriber. responses: 200: description: OK schema: $ref: '#/definitions/ResultSet' 202: description: Accepted schema: $ref: '#/definitions/ResultSet' 400: description: Bad Request schema: $ref: '#/definitions/ErrorResponse' 401: description: Not Authorized schema: $ref: '#/definitions/ErrorResponse' 403: description: Forbidden schema: $ref: '#/definitions/ErrorResponse' 500: description: Internal Server Error schema: $ref: '#/definitions/ErrorResponse' /coverages/{id}: get: summary: Get the full coverage information by id. operationId: getCoverageById produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 200: description: OK schema: $ref: '#/definitions/Coverage' 401: description: Not Authorized schema: $ref: '#/definitions/ErrorResponse' 403: description: Forbidden schema: $ref: '#/definitions/ErrorResponse' 404: description: Not Found schema: $ref: '#/definitions/ErrorResponse' 500: description: Internal Server Error schema: $ref: '#/definitions/ErrorResponse' delete: summary: Delete a coverage information by id. operationId: deleteCoverageById produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 204: description: No Content 401: description: Not Authorized schema: $ref: '#/definitions/ErrorResponse' 403: description: Forbidden schema: $ref: '#/definitions/ErrorResponse' 404: description: Not Found schema: $ref: '#/definitions/ErrorResponse' 500: description: Internal Server Error schema: $ref: '#/definitions/ErrorResponse' parameters: - name: id type: string required: true in: path description: A coverage id definitions: ResultSet: type: object properties: totalCount: type: integer description: Total number of assets. count: type: integer description: Number of assets in the result set. offset: type: integer description: Paging offset. limit: type: integer description: Paging limit. links: type: object description: Links. additionalProperties: $ref: '#/definitions/Link' coverages: type: array description: list of coverages items: $ref: '#/definitions/CoverageSummary' Link: type: object properties: href: type: string description: The URL. CoverageSummary: type: object properties: id: type: string description: The id of the coverage. customerId: type: string description: The id of the customer that owns this coverage. createdDate: type: string format: date-time description: The time and date when this coverage was added to our system. updatedDate: type: string format: date-time description: The time and date when this coverage was last updated in our system. expirationDate: type: string format: date-time description: The time and date when this coverage will expire from our system. controlNumber: type: string description: A tracking number we assigned to the coverage transaction. submitterStatecode: type: string description: The submitting customer's configured state code. status: type: string description: The current status of the coverage request. statusCode: type: string description: The current status code of the coverage request. asOfDate: type: string format: date-time description: The as of date. toDate: type: string format: date-time description: The to date. cardIssueDate: type: string format: date-time description: The card issue date. payer: type: object description: The payer. properties: payerId: type: string description: The requested payer id. name: type: string description: The requested payer name. responsePayerId: type: string description: The id the payer responded with. responseName: type: string description: The name the payer responded with. requestingProvider: type: object description: The requesting provider. properties: lastName: type: string description: The requesting provider's last or business name. firstName: type: string description: The requesting provider's first name. type: type: string description: The requesting provider's type. typeCode: type: string description: The requesting provider's type code. specialtyCode: type: string description: The requesting provider's specialty code. npi: type: string description: The requesting provider's national provider id. taxId: type: string description: The requesting provider's tax id. payerAssignedProviderId: type: string description: The requesting provider's payer assigned provider id. ssn: type: string description: The requesting provider's SSN. submitterId: type: string description: The requesting provider's submitter id. placeOfService: type: string description: The requesting provider's place of service. placeOfServiceCode: type: string description: The requesting provider's place of service code. address: type: object description: The requesting provider's address. properties: city: type: string description: The requesting provider's city. state: type: string description: The requesting provider's state. stateCode: type: string description: The requesting provider's state code. zipCode: type: string description: The requesting provider's ZIP code. pin: type: string description: The requesting provider's PIN. patient: type: object description: The patient. properties: lastName: type: string description: The patient's last name. firstName: type: string description: The patient's first name. middleName: type: string description: The patient's middle name. suffix: type: string description: The patient's suffix. birthDate: type: string format: date-time description: The patient's birth date. ssn: type: string description: The patient's SSN. gender: type: string description: The patient's gender. genderCode: type: string description: The patient's gender code. subscriberRelationship: type: string description: The patient's subscriber relationship. subscriberRelationshipCode: type: string description: The patient's subscriber relationship code. address: type: object description: The patient's address. properties: state: type: string description: The patient's state. stateCode: type: string description: The patient's state code. subscriber: type: object description: The subscriber. properties: memberId: type: string description: The subscriber's member id. medicaidId: type: string description: The subscriber's medicaid id. lastName: type: string description: The subscriber's last name. firstName: type: string description: The subscriber's first name. middleName: type: string description: The subscriber's middle name. suffix: type: string description: The subscriber's suffix. birthDate: type: string format: date-time description: The subscriber's birth date. gender: type: string description: The subscriber's gender. genderCode: type: string description: The subscriber's gender code. caseNumber: type: string description: The subscriber's case number. plans: type: array description: A list of plans. items: type: object description: A plan. properties: status: type: string description: The plan's status. statusCode: type: string description: The plan's status code. identityCardNumber: type: string description: The plan's identity card number. groupNumber: type: string description: The plan's group number. groupName: type: string description: The plan's group name. description: type: string description: The plan's description. coverageSummaryAdditionalPayers: type: array description: A list of coverage summary additional payers. items: type: object description: A coverage summary additional payer. properties: name: type: string description: The coverage summary additional payer's name. serviceTypeCode: type: string description: The coverage summary additional payer's service type code. insuredMemberId: type: string description: The coverage summary additional payer's insured member id. primary: type: boolean description: Indicates whether or not this is a primary payer. secondary: type: boolean description: Indicates whether or not this is a secondary payer. tertiary: type: boolean description: Indicates whether or not this is a tertiary payer. coordinationOfBenefitsBeginDate: type: string format: date-time description: The coverage summary additional payer's coordination of benefits begin date. coordinationOfBenefitsEndDate: type: string format: date-time description: The coverage summary additional payer's coordination of benefits end date. coordinationOfBenefitsDate: type: string description: The coverage summary additional payer's coordination of benefits date. eligibilityStartDate: type: string format: date-time description: The plan's eligibility start date. eligibilityEndDate: type: string format: date-time description: The plan's eligibility end date. coverageStartDate: type: string format: date-time description: The plan's coverage start date. coverageEndDate: type: string format: date-time description: The plan's coverage end date. insuranceType: type: string description: The plan's insurance type. insuranceTypeCode: type: string description: The plan's insurance type code. primaryCareProvider: type: object description: The plan primary care provider. properties: name: type: string description: The primary care provider's name. category: type: string description: The primary care provider's category. categoryCode: type: string description: The primary care provider's category code. requestedServiceType: type: array description: The requested service types. items: type: object description: A requested service type. properties: code: type: string description: The requested service type code. value: type: string description: The requested service type description. procedureCode: type: array description: Requested procedure codes. items: type: string description: A requested procedure code. validationMessages: type: array description: A list of validation messages from the payer. items: $ref: '#/definitions/FieldError' Coverage: type: object properties: id: type: string description: The id of the coverage. customerId: type: string description: The id of the customer that owns this coverage. controlNumber: type: string description: A control number that we assigned to the coverage transaction. status: type: string description: The current status of the coverage request. statusCode: type: string description: The current status code of the coverage request. submitterStatecode: type: string description: The state code of the submitting customer. createdDate: type: string format: date-time description: The date and time when this coverage was added to our system. updatedDate: type: string format: date-time description: The date and time when this coverage was last updated in our system. expirationDate: type: string format: date-time description: The date and time when this coverage will expire from our system. asOfDate: type: string format: date-time description: The as of date. toDate: type: string format: date-time description: The to date. cardIssueDate: type: string format: date-time description: The card issue date. requestedServiceType: type: array description: The requested service types. items: type: object description: A requested service type. properties: code: type: string description: The requested service type code. value: type: string description: The requested service type description. procedureCode: type: array description: Requested procedure codes. items: type: string description: A requested procedure code. validationMessages: type: array description: A list of validation messages from the payer. items: $ref: '#/definitions/FieldError' subscriber: type: object description: The subscriber. properties: firstName: type: string description: The subscriber's first name. middleName: type: string description: The subscriber's middle name. lastName: type: string description: The subscriber's last name. suffix: type: string description: The subscriber's suffix. memberId: type: string description: The subscriber's member id. medicaidId: type: string description: The subscriber's medicaid id. gender: type: string description: The subscriber's gender. genderCode: type: string description: The subscriber's gender code. ssn: type: string description: The subscriber's SSN. birthDate: type: string format: date-time description: The subscriber's birth date. address: $ref: '#/definitions/Address' caseNumber: type: string description: The subscriber's case number. patient: type: object description: The patient. properties: firstName: type: string description: The patient's first name. middleName: type: string description: The patient's middle name. lastName: type: string description: The patient's last name. suffix: type: string description: The patient's suffix. patientAccountNumber: type: string description: The patient's account number. memberId: type: string description: The patient's member id. familyUnitNumber: type: string description: The patient's family unit number. subscriberRelationship: type: string description: The patient's relationship to the subscriber. subscriberRelationshipCode: type: string description: The patient's relationship to subscriber code. gender: type: string description: The patient's gender. genderCode: type: string description: The patient's gender code. ssn: type: string description: The patient's SSN. birthDate: type: string format: date-time description: The patient's birth date. deathDate: type: string format: date-time description: The patient's death date. address: $ref: '#/definitions/Address' updateYourRecords: type: boolean description: Indicates that you need to update your copy of the patient's demographic information. payer: $ref: '#/definitions/Payer' requestingProvider: $ref: '#/definitions/HealthCareContact' plans: type: array description: Policy plan information. items: type: object properties: status: type: string description: The current plan status. statusCode: type: string description: The current plan status code. groupNumber: type: string description: The plan's group number. groupName: type: string description: The plan's group name. policyNumber: type: string description: The policy number. planNumber: type: string description: The plan number. planName: type: string description: The plan name. planNetworkId: type: string description: The network id. planNetworkName: type: string description: The network name. contractClassCode: type: string description: The patient's contract class code. contractNumber: type: string description: The patient's contract number. medicalRecordNumber: type: string description: The patient's medical record number. healthInsuranceClaimNumber: type: string description: The patient's health insurance claim number. identificationCardSerialNumber: type: string description: The patient's identification card serial number. identityCardNumber: type: string description: The patient's identity card number. issueNumber: type: string description: The patient's issue number. medicaidRecipientIdentificationNumber: type: string description: The patient's medicaid recipient identification number. priorIdentificationNumber: type: string description: The patient's prior identification number. agencyClaimNumber: type: string description: The patient's agency claim number. admissionDate: type: string format: date-time description: The date the patient was admitted. dischargeDate: type: string format: date-time description: The date the patient was discharged. issueDate: type: string format: date-time description: The date this issue was created. serviceDate: type: string format: date-time description: The date of service. coverageStartDate: type: string format: date-time description: The start date of coverage. coverageEndDate: type: string format: date-time description: The end date of coverage. planStartDate: type: string format: date-time description: The start date of the plan. planEndDate: type: string format: date-time description: The end date of the plan. planEnrollmentDate: type: string format: date-time description: The enrollment date. certificationDate: type: string format: date-time description: The certification date. eligibilityStartDate: type: string format: date-time description: The eligibility start date. eligibilityEndDate: type: string format: date-time description: The eligibility end date. policyEffectiveDate: type: string format: date-time description: The effective date of the policy. policyExpirationDate: type: string format: date-time description: The expiration date of the policy. effectiveChangeDate: type: string format: date-time description: The last effective plan change date. cobraStartDate: type: string format: date-time description: COBRA start date. cobraEndDate: type: string format: date-time description: COBRA end date. lastUpdateDate: type: string format: date-time description: The date this was last updated addedDate: type: string format: date-time description: The date this was added. premiumPaidToBeginDate: type: string format: date-time description: The date start date for premium paid to begin. premiumPaidToEndDate: type: string format: date-time description: The date end date for premium paid to begin. periodStartDate: type: string format: date-time description: The start date for the period. periodEndDate: type: string format: date-time description: The end date for the period. statusDate: type: string format: date-time description: The status date. additionalPayers: type: array description: Additional payer information including primary, secondary, and tertiary payers. items: $ref: '#/definitions/Payer' primaryCareProvider: $ref: '#/definitions/HealthCareContact' contacts: type: array description: Contacts associated with the patient. items: $ref: '#/definitions/HealthCareContact' benefits: type: array description: Service coverage benefit information. items: $ref: '#/definitions/Benefit' preexistingConditions: $ref: '#/definitions/BenefitDetail' costContainment: $ref: '#/definitions/BenefitDetail' limitations: $ref: '#/definitions/BenefitDetail' benefitDescriptions: $ref: '#/definitions/BenefitDetail' coverageBasis: $ref: '#/definitions/BenefitDetail' insuranceType: type: string description: The type of insurance. insuranceTypeCode: type: string description: The code of the type of insurance. reserve: $ref: '#/definitions/BenefitDetail' payerNotes: type: array description: General payer notes and disclaimers. items: $ref: '#/definitions/PayerNote' supplementalInformation: type: object description: asdf properties: professionalPatientCostEstimator: type: boolean description: Indicates whether or not Professional Patient Cost Estimator is available. institutionalPatientCostEstimator: type: boolean description: Indicates whether or not Institutional Patient Cost Estimator is available. patientCareSummary: type: boolean description: Indicates whether or not a Patient Care Summary is available. patientCareSummaryReason: type: string description: Indicates the reason for the patient care summary availability. patientCareSummaryReasonCode: type: string description: Indicates the reason for the patient care summary availability. assessmentCarePlan: type: boolean description: Indicates whether or not Assessment and Care Plan is available. thirdPartySystemId: type: string description: Third party system id for supplemental information. routingCode: type: string description: Routing code for supplemental information. outOfArea: type: boolean description: Out of area flag indicated by certain payers. clickToTalkPhoneNumber: type: string description: The Click to Talk phone number. clickToTalkKey: type: string description: The Click to Talk key. localMemberId: type: string description: Local member id for third party clinical exchanges pceMemberLocatorKey: type: string description: Local member key for patient cost estimator for third party clinical exchanges pceHostIndicator: type: boolean description: Host plan indicator for patient cost estimator for third party clinical exchanges referralShortFormIndicator: type: boolean description: Referral short form indicator viewReferralAuthIndicator: type: boolean description: View all auths and referrals indicator csnpIndicator: type: boolean description: C-SNP form indicator requestLtssccAmount: type: boolean description: Flag indicating whether or not to initiate a request to LTSSCC pregnant: type: boolean description: Patient Assessment (Maternity) form exists pharmacyRestrictions: type: object description: Pharmacy restrictions. properties: lockInInfo: type: array description: Lock in information. items: type: object properties: name: type: string description: A name. address: type: object description: An address. properties: line1: type: string description: A street address. line2: type: string description: A street address. city: type: string description: A city. state: type: string description: A state. zipCode: type: string description: A ZIP code. telephone: type: string description: A telephone. fax: type: string description: A fax. effectiveDt: type: string format: date-time description: An effective date. terminationDt: type: string format: date-time description: A termination date. erReferralCompleted: type: boolean description: ER Referral Questionaire reminders: type: object description: Care remdinders pertaining to this coverage. properties: titles: type: object description: Clinical message titles. additionalProperties: type: string messages: type: array description: Clinical message content. items: type: object additionalProperties: type: object inference: type: string description: Clinical inference. Address: type: object properties: line1: type: string description: The street address. line2: type: string description: The street address. city: type: string description: The city. state: type: string description: The state. stateCode: type: string description: The state code. zipCode: type: string description: The ZIP code. Payer: type: object properties: type: type: string description: The payer's type. typeCode: type: string description: The payer's type code. name: type: string description: The payer's name. payerId: type: string description: The payer's id. responseName: type: string description: The payer's response name. responsePayerId: type: string description: The payer's response id. primary: type: boolean description: Indicates whether or not this is the primary payer. secondary: type: boolean description: Indicates whether or not this is the seconday payer. tertiary: type: boolean description: Indicates whether or not this is the tertiary payer. thirdPartyAdministrator: type: string description: Indicates if this payer is a Third-Party Administrator. insuredLastName: type: string description: The insured person's last name. insuredFirstName: type: string description: The insured person's first name. insuredMiddleName: type: string description: The insured person's middle name. insuredMemberId: type: string description: The insured person's member id. insuredAddress: $ref: '#/definitions/Address' groupNumber: type: string description: The plan's group number. groupName: type: string description: The plan's group name. policyNumber: type: string description: The policy number. planNumber: type: string description: The plan number. planName: type: string description: The plan name. planNetworkId: type: string description: The network id. planNetworkName: type: string description: The network name. memberIdentificationNumber: type: string description: The member's identification number. familyUnitNumber: type: string description: The family unit number. healthInsuranceClaimNumber: type: string description: The patient's health insurance claim number. medicaidRecipientIdentificationNumber: type: string description: The patient's medicaid recipient identification number. dischargeDate: type: string format: date-time description: The discharge date. periodStartDate: type: string format: date-time description: The start date of the period. periodEndDate: type: string format: date-time description: The end date of the period. completionDate: type: string format: date-time description: The completion date. coordinationOfBenefitsDate: type: string format: date-time description: The coordination of benefits date. coordinationOfBenefitsBeginDate: type: string format: date-time description: The coordination of benefits begin date. coordinationOfBenefitsEndDate: type: string format: date-time description: The coordination of benefits end date. coverageStartDate: type: string format: date-time description: The start date of the coverage. coverageEndDate: type: string format: date-time description: The end date of the coverage. addedDate: type: string format: date-time description: The added date of the plan. planStartDate: type: string format: date-time description: The start date of the plan. primaryCareProviderDate: type: string format: date-time description: The primary care provider date. lastVisitDate: type: string format: date-time description: The date of the latest visit or consultation. eligibilityStartDate: type: string format: date-time description: The eligibility start date. eligibilityEndDate: type: string format: date-time description: The eligibility end date. benefitBeginDate: type: string format: date-time description: The benefit begin date. benefitEndDate: type: string format: date-time description: The benefit end date. admissionDate: type: string format: date-time description: The admission date. serviceDate: type: string format: date-time description: The service date. lastUpdateDate: type: string format: date-time description: The date this was last updated statusDate: type: string format: date-time description: The status date. insuredContactInformation: type: array description: Contact information for the insured person. items: $ref: '#/definitions/ContactInformation' address: $ref: '#/definitions/Address' contactInformation: type: array description: Contact information for the payer. items: $ref: '#/definitions/ContactInformation' payerNotes: type: array description: Notes from the payer about this additional payer. items: type: string serviceTypeCode: type: string description: The service type code with which this payer is associated. ContactInformation: type: object properties: name: type: string description: The contact name. phone: type: string description: A phone number. workPhone: type: string description: A work phone number. fax: type: string description: A fax number. emailAddress: type: string description: An email address. url: type: string description: A contact URL. ediAccessNumber: type: string description: A contact EDI access number. HealthCareContact: type: object properties: category: type: string description: The contact category. categoryCode: type: string description: The contact category code. type: type: string description: The type of contact. typeCode: type: string description: The type code of the contact. role: type: string description: The role of contact. roleCode: type: string description: The role code of the contact. name: type: string description: The name of the contact. firstName: type: string description: The first name of the contact. middleName: type: string description: The middle name of the contact. lastName: type: string description: The last name of the contact. npi: type: string description: The NPI of the contact. taxId: type: string description: The tax id of the contact. stateLicenseNumber: type: string description: The state license number of the contact. medicareProviderNumber: type: string description: The Medicare provider number of the contact. medicaidProviderNumber: type: string description: The Medicaid provider number of the contact. facilityId: type: string description: The facility ID of the contact. pin: type: string description: The Personal Identification Number of the contact. contractNumber: type: string description: The contract number of the contact. electronicPin: type: string description: The electronic device pin number of the contact. providerPlanNetworkId: type: string description: The provider plan network identification number of the contact. facilityNetworkId: type: string description: The facility network identification number of the contact. ssn: type: string description: The social security number of the contact. ein: type: string description: The employer's identification number etin: type: string description: Electronic transmitter identification number payerId: type: string description: The payor identification pharmacyProcessorNumber: type: string description: The pharmacy processor number planId: type: string description: The CMMS plan ID policyNumber: type: string description: Group or Policy Number memberId: type: string description: The Member Identification Number familyUnitNumber: type: string description: Family Unit Number groupNumber: type: string description: Group Number referralNumber: type: string description: Referral Number alternateListId: type: string description: Alternative List ID coverageListlId: type: string description: Coverage List ID healthInsuranceClaimNumber: type: string description: Health Insurance Claim (HIC) Number drugFormularyNumber: type: string description: Drug Formulary Number priorAuthorizationNumber: type: string description: Prior Authorization Number medicalAssistanceCategoryId: type: string description: Medical Assistance Category planNetworkId: type: string description: Plan Network Identification Number planNetworkName: type: string description: Plan Network Name medicaidRecipientId: type: string description: Medicaid Recipient Identification Number suhi: type: string description: Standard Unique Health Identifier for each Individual in the United States naicId: type: string description: The National Association of Insurance Commissioners Identification payerAssignedProviderId: type: string description: The payer assigned provider id of the v. submitterId: type: string description: The submitter id of the contact. payerAssignedUserId: type: string description: The payer assigned user id of the contact. specialty: type: string description: The specialty of the contact. specialtyCode: type: string description: The specialty code of the contact. placeOfService: type: string description: The place of contact. placeOfServiceCode: type: string description: The place of service code. dischargeDate: type: string format: date-time description: The discharge date. periodStartDate: type: string format: date-time description: The start date of the period. periodEndDate: type: string format: date-time description: The end date of the period. completionDate: type: string format: date-time description: The completion date. coordinationOfBenefitsDate: type: string format: date-time description: The coordination of benefits date. coordinationOfBenefitsBeginDate: type: string format: date-time description: The coordination of benefits begin date. coordinationOfBenefitsEndDate: type: string format: date-time description: The coordination of benefits end date. coverageStartDate: type: string format: date-time description: The start date of the coverage. coverageEndDate: type: string format: date-time description: The end date of the coverage. addedDate: type: string format: date-time description: The added date of the plan. planStartDate: type: string format: date-time description: The start date of the plan. primaryCareProviderDate: type: string format: date-time description: The primary care provider date. primaryCareProviderStartDate: type: string format: date-time description: The primary care provider start date. primaryCareProviderEndDate: type: string format: date-time description: The primary care provider end date. lastVisitDate: type: string format: date-time description: The date of the latest visit or consultation. eligibilityStartDate: type: string format: date-time description: The eligibility start date. eligibilityEndDate: type: string format: date-time description: The eligibility end date. benefitBeginDate: type: string format: date-time description: The benefit begin date. benefitEndDate: type: string format: date-time description: The benefit end date. admissionDate: type: string format: date-time description: The admission date. serviceDate: type: string format: date-time description: The service date. lastUpdateDate: type: string format: date-time description: The date this was last updated statusDate: type: string format: date-time description: The status date. authorizationRequired: type: boolean description: Indicates whether or not the provider is required to obtain authorization to perform this service. address: $ref: '#/definitions/Address' contactInformation: type: array description: Contact information for the contact. items: $ref: '#/definitions/ContactInformation' deliveryInformation: type: array description: Delivery information for the contact. items: $ref: '#/definitions/HealthCareServiceDelivery' payerNotes: type: array description: Payer notes about this contact items: type: string HealthCareServiceDelivery: type: object properties: quantityQualifier: type: string description: The type of service to be delivered. quantityQualifierCode: type: string description: The type code of service to be delivered. quantity: type: string description: The quantity of the service to be delivered. amount: type: string description: The amount per period to deliver. per: type: string description: The frequency period over which to deliver the service. perCode: type: string description: The frequency period code over which to deliver the service. timePeriod: type: string description: The time period measurement that this service should be delivered over. timePeriodCode: type: string description: The code of the time period measurement that this service should be delivered over. timePeriods: type: string description: The number of periods to deliver this service for. pattern: type: string description: The pattern in which to deliver this service. patternCode: type: string description: The code of the pattern in which to deliver this service. time: type: string description: The time of day to deliver this service. timeCode: type: string description: The code of the time of day to deliver this service. NetworkBenefit: type: object properties: status: type: string description: The status of coverage for this benefit. statusCode: type: string description: The status code of the coverage for this benefit. insuranceType: type: string description: The type of insurance. insuranceTypeCode: type: string description: The code of the type of insurance. amount: type: string description: The amount. units: type: string description: The units of the amount. amountTimePeriod: type: string description: The time period that this benefit applies to. amountTimePeriodCode: type: string description: The code of the time period for this benefit. remaining: type: string description: The remaining amount. remainingTimePeriod: type: string description: The time period that the remaining benefit applies to. remainingTimePeriodCode: type: string description: The code of the remaining time period for this benefit. total: type: string description: The total amount. totalTimePeriod: type: string description: The time period that the total benefit applies to. totalTimePeriodCode: type: string description: The code of the total time period for this benefit. level: type: string description: The level of coverage. levelCode: type: string description: The code of the level of coverage. quantity: type: string description: The quantity covered by this benefit. quantityQualifier: type: string description: The qualifier for the quantity amount. quantityQualifierCode: type: string description: The qualifier code for the quantity amount. authorizationRequired: type: boolean description: Indicates whether or not the provider is required to obtain authorization to perform this service. authorizationRequiredUnknown: type: boolean description: Indicates if whether or not the provider is required to obtain authorization to perform this service is unknown. placeOfService: type: string description: The place where this service should be performed. placeOfServiceCode: type: string description: The code of the place where this service should be performed. description: type: string description: A description of this benefit. planNumber: type: string description: The plan number. planName: type: string description: The plan name. policyNumber: type: string description: The policy number. memberIdentificationNumber: type: string description: The member's identification number. familyUnitNumber: type: string description: The family unit number. groupNumber: type: string description: The benefit's group number. groupName: type: string description: The benefit's group name. referralNumber: type: string description: The referral number. healthInsuranceClaimNumber: type: string description: The patient's health insurance claim number. priorAuthorizationNumber: type: string description: The patient's prior authorization number. insurancePolicyNumber: type: string description: The insurance policy number. planNetworkId: type: string description: The plan network identification number. planNetworkName: type: string description: The plan network name. medicaidRecipientIdentificationNumber: type: string description: The patient's medicaid recipient identification number. dischargeDate: type: string format: date-time description: The discharge date. periodStartDate: type: string format: date-time description: The start date of the period. periodEndDate: type: string format: date-time description: The end date of the period. completionDate: type: string format: date-time description: The completion date. coordinationOfBenefitsDate: type: string format: date-time description: The coordination of benefits date. coordinationOfBenefitsBeginDate: type: string format: date-time description: The coordination of benefits begin date. coordinationOfBenefitsEndDate: type: string format: date-time description: The coordination of benefits end date. coverageStartDate: type: string format: date-time description: The start date of the coverage. coverageEndDate: type: string format: date-time description: The end date of the coverage. addedDate: type: string format: date-time description: The added date of the plan. planStartDate: type: string format: date-time description: The start date of the plan. primaryCareProviderDate: type: string format: date-time description: The primary care provider date. lastVisitDate: type: string format: date-time description: The date of the latest visit or consultation. eligibilityStartDate: type: string format: date-time description: The eligibility start date. eligibilityEndDate: type: string format: date-time description: The eligibility end date. benefitBeginDate: type: string format: date-time description: The benefit begin date. benefitEndDate: type: string format: date-time description: The benefit end date. admissionDate: type: string format: date-time description: The admission date. serviceDate: type: string format: date-time description: The service date. lastUpdateDate: type: string format: date-time description: The date this was last updated statusDate: type: string format: date-time description: The status date. contacts: type: array description: Contacts for this benefit items: $ref: '#/definitions/ContactInformation' payerNotes: type: array description: Free form notes from the payer that apply to this benefit. items: type: string deliveryInformation: type: array description: Health care service delivery information. items: $ref: '#/definitions/HealthCareServiceDelivery' BenefitDetail: type: object properties: inNetwork: type: array description: Benefits that apply to in-network providers. items: $ref: '#/definitions/NetworkBenefit' outOfNetwork: type: array description: Benefits that apply to out-of-network providers. items: $ref: '#/definitions/NetworkBenefit' notApplicableNetwork: type: array description: Benefits that apply regardless of network. items: $ref: '#/definitions/NetworkBenefit' noNetwork: type: array description: Benefits that are not specific to a network. items: $ref: '#/definitions/NetworkBenefit' Amounts: type: object properties: coPayment: $ref: '#/definitions/BenefitDetail' outOfPocket: $ref: '#/definitions/BenefitDetail' deductibles: $ref: '#/definitions/BenefitDetail' coInsurance: $ref: '#/definitions/BenefitDetail' PayerNote: type: object properties: type: type: string description: The type of note. typeCode: type: string description: The type code of the note. message: type: string description: The message from the payer. Benefit: type: object properties: name: type: string description: The name of the benefit. type: type: string description: The type of the benefit. source: type: string description: The source of the procedure benefit. status: type: string description: The status of coverage for this benefit. statusCode: type: string description: The status code of the coverage for this benefit. statusDetails: $ref: '#/definitions/BenefitDetail' amounts: $ref: '#/definitions/Amounts' limitations: $ref: '#/definitions/BenefitDetail' benefitDescriptions: $ref: '#/definitions/BenefitDetail' nonCovered: $ref: '#/definitions/BenefitDetail' coverageBasis: $ref: '#/definitions/BenefitDetail' reserve: $ref: '#/definitions/BenefitDetail' preexistingConditions: $ref: '#/definitions/BenefitDetail' costContainment: $ref: '#/definitions/BenefitDetail' exclusions: $ref: '#/definitions/BenefitDetail' additionalPayers: type: array description: Additional payers for this benefit. items: $ref: '#/definitions/Payer' contacts: type: array description: Additional contacts for this benefit. items: $ref: '#/definitions/HealthCareContact' payerNotes: type: array description: Payer notes, disclaimers, and descriptions. items: $ref: '#/definitions/PayerNote' ErrorResponse: type: object properties: userMessage: type: string description: A high level error message. developerMessage: type: string description: A more technical error message. reasonCode: type: integer description: A reason code. statusCode: type: integer description: The status code. errors: type: array description: A list of detailed user friendly messages. items: $ref: '#/definitions/FieldError' FieldError: type: object properties: field: type: string description: The field or parameter associated with this error. code: type: string description: A code for the error. errorMessage: type: string description: The message associated with this error. index: type: integer description: The array index of the item associated with this error. x-ibm-endpoints: - endpointUrl: https://api.availity.com/availity description: Custom API Endpoint type: - production ...