--- swagger: "2.0" info: x-ibm-name: claim-statuses title: Claim Statuses version: 1.0.0 description: "" schemes: - https basePath: /v1 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: /claim-statuses: get: summary: Initiate a new claim status request or view an existing request. operationId: findClaimStatus produces: - application/json - application/xml parameters: - name: payer.id type: string in: query description: The Availity payer id of the member. - name: submitter.lastName type: string in: query description: The submitter's last or business name. - name: submitter.firstName type: string in: query description: The submitter's first name. - name: submitter.middleName type: string in: query description: The submitter's middle name. - name: submitter.suffix type: string in: query description: The submitter's suffix. - name: submitter.id type: string in: query description: The submitter's id. - name: providers.lastName type: string in: query description: The provider's last name. - name: providers.firstName type: string in: query description: The provider's first name. - name: providers.middleName type: string in: query description: The provider's middle name. - name: providers.suffix type: string in: query description: The provider's suffix. - name: providers.npi type: string in: query description: The provider's national provider id. - name: providers.taxId type: string in: query description: The provider's tax id. - name: providers.payerAssignedProviderId type: string in: query description: The provider's payer assigned provider id. - name: subscriber.memberId type: string in: query description: The subscriber's member id. - name: subscriber.lastName type: string in: query description: The subscriber's last name. - name: subscriber.firstName type: string in: query description: The subscriber's first name. - name: subscriber.middleName type: string in: query description: The subscriber's middle name. - name: subscriber.suffix type: string in: query description: The subscriber's suffix. - name: patient.lastName type: string in: query description: The patient's last name. - name: patient.firstName type: string in: query description: The patient's first name. - name: patient.middleName type: string in: query description: The patient's middle name. - name: patient.suffix type: string in: query description: The patient's suffix. - name: patient.birthDate type: string format: date in: query description: The patient's birth date. - name: patient.genderCode type: string in: query description: The patient's gender code. - name: patient.accountNumber type: string in: query description: The patient's account number. - name: patient.subscriberRelationshipCode type: string in: query description: The patient's relationship to subscriber code. - name: fromDate type: string format: date in: query description: The service from date. - name: toDate type: string format: date in: query description: The service to date. - name: claimNumber type: string in: query description: The health plan's claim tracking number assigned when the original claim was received and processed. - name: claimAmount type: string in: query description: The total claim charge amount of the original claim processed by the health plan. - name: facilityTypeCode type: string in: query description: The code identifying where services were, or may have been, performed for institutional claims. - name: frequencyTypeCode type: string in: query description: The code identifying the frequency of an institutional claim. responses: 200: description: OK schema: $ref: '#/definitions/ResultSet' 202: description: Accepted headers: Location: type: string description: Location of the claim status. X-Status-Message: type: string description: Current status of the pending request. 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' /claim-statuses/{id}: get: summary: Get the full claim status information by id. operationId: getClaimStatusById produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 200: description: OK schema: $ref: '#/definitions/ClaimStatus' 202: description: Accepted headers: Location: type: string description: Location of the claim status. X-Status-Message: type: string description: Current status of the pending request. schema: $ref: '#/definitions/ClaimStatus' 400: description: Bad Request schema: $ref: '#/definitions/ErrorResponse' 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: responses: 200: description: 200 OK parameters: - name: id type: string required: true in: path description: A claim status 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' claimStatuses: type: array description: list of claim statuses items: $ref: '#/definitions/ClaimStatusSummary' Link: type: object properties: href: type: string description: The URL. ClaimStatusSummary: type: object properties: id: type: string description: The id of the claim status. customerId: type: string description: The id of the customer that owns this claim status. createdDate: type: string format: date-time description: The date and time when this claim status was added to our system. updatedDate: type: string format: date-time description: The date and time when this claim status was last updated in our system. expirationDate: type: string format: date-time description: The date and time when this claim status will expire from our system. controlNumber: type: string description: A tracking number we assigned to the transaction with the payer. status: type: string description: The current status of the claim status request. statusCode: type: string description: The current status code of the claim status request. payer: type: object description: The claim payer. properties: id: type: string description: The payer's id. submitter: type: object description: The claim submitter. properties: lastName: type: string description: The submitter's last name. firstName: type: string description: The submitter's first name. middleName: type: string description: The submitter's middle name. suffix: type: string description: The submitter's suffix. id: type: string description: The submitter's id. providers: type: array description: The claim providers. items: type: object properties: lastName: type: string description: The provider's last or business name. firstName: type: string description: The provider's first name. middleName: type: string description: The provider's middle name. suffix: type: string description: The provider's suffix. npi: type: string description: The provider's national provider id. taxId: type: string description: The provider's tax id. payerAssignedProviderId: type: string description: The provider's payer assigned provider id. 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 description: The patient's birth date. gender: type: string description: The patient's gender. genderCode: type: string description: The patient's gender code. accountNumber: type: string description: The patient's account number. subscriberRelationship: type: string description: The patient's relationship to subscriber. subscriberRelationshipCode: type: string description: The patient's relationship to subscriber code. subscriber: type: string description: The subscriber. properties: 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. memberId: type: string description: The subscriber's member id. fromDate: type: string format: date description: The service from date. toDate: type: string format: date description: The service to date. claimNumber: type: string description: The claim number. claimAmount: type: string description: The claim amount. facilityTypeCode: type: string description: The facility type code. facilityType: type: string description: The facility type. frequencyTypeCode: type: string description: The frequency type code. frequencyType: type: string description: The frequency type. claimCount: type: string description: The claim count. ClaimStatus: type: object properties: id: type: string description: The id of the claim status. customerId: type: string description: The Availity Customer ID of the customer that owns this claim status. controlNumber: type: string description: The control number of the X12 request that this claim status was created from. userId: type: string description: The User ID of the customer that owns this claim status. status: type: string description: The status of the claim status lookup. statusCode: type: string description: The status code of the claim status lookup. createdDate: type: string format: date-time description: The date this claim status entry was created. updatedDate: type: string format: date-time description: The date when this claim status entry was last updated. expirationDate: type: string format: date-time description: The date when this claim status entry expires. fromDate: type: string format: date description: The from date specified in the initial claim status inquiry request. toDate: type: string format: date description: The to date specified in the initial claim status inquiry request. claimNumber: type: string description: The claim number specified in the initial claim status inquiry request. claimAmount: type: string description: The claim charge amount specified in the initial claim status inquiry request. facilityTypeCode: type: string description: The facility type code specified in the initial claim status inquiry request. facilityType: type: string description: The facility type description. frequencyTypeCode: type: string description: The frequency type code specified in the initial claim status inquiry request. frequencyType: type: string description: The frequency type description. payer: $ref: '#/definitions/Payer' submitter: $ref: '#/definitions/Submitter' providers: type: array description: Provider of services from the original claim. items: $ref: '#/definitions/Provider' subscriber: $ref: '#/definitions/Subscriber' patient: $ref: '#/definitions/Patient' claimStatuses: type: array description: The claim statuses. items: $ref: '#/definitions/ClaimStatusResult' claimCount: type: string description: The number of distinct claims included in the status response. Payer: type: object properties: id: type: string description: Claim status payer id name: type: string description: Claim status payer name contactName: type: string description: Full Name phone: type: string description: Phone Number extension: type: string description: Extension fax: type: string description: Fax emailAddress: type: string description: E-mail Address ediAccessNumber: type: string description: Electronic Data Interchange Access Number Submitter: type: object properties: lastName: type: string description: The last name of an individual or the name of an organization submitting the claim status inquiry. firstName: type: string description: The first name of an individual submitter. middleName: type: string description: The middle name of an individual submitter. suffix: type: string description: The suffix of an individual submitter. id: type: string description: The submitter's identification number. statusDetails: type: array description: Reports the status, required action, and paid information of a claim or service line. items: $ref: '#/definitions/ClaimStatusDetail' traceId: type: string description: Referenced transaction trace identifier. Provider: type: object properties: lastName: type: string description: The last name of an individual or the name of an organization that provided services on the original claim. firstName: type: string description: The first name of an individual provider. middleName: type: string description: The middle name of an individual provider. suffix: type: string description: The suffix of an individual provider. npi: type: string description: The NPI of a provider. taxId: type: string description: The tax id of a provider. payerAssignedProviderId: type: string description: The payer assigned provider id of a provider. statusDetails: type: array description: Reports the status, required action, and paid information of a claim or service line. items: $ref: '#/definitions/ClaimStatusDetail' traceId: type: string description: Referenced transaction trace identifier. Subscriber: type: object 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 health plan member id of the subscriber. taxId: type: string description: The subscriber's tax id. Patient: type: object 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. birthDate: type: string format: date description: The patient's date of birth. gender: type: string description: The patient's gender. genderCode: type: string description: The patient's gender code. accountNumber: type: string description: The service provider's patient identifier. subscriberRelationship: type: string description: The patient's relationship to the subscriber or policy holder. subscriberRelationshipCode: type: string description: The patient's relationship code to the subscriber or policy holder. ClaimStatusResult: type: object properties: traceId: type: string description: Referenced transaction trace identifier. claimControlNumber: type: string description: The payer’s assigned control number, also known as, Internal Control Number (ICN), Document Control Number (DCN), or Claim Control Number (CCN). facilityTypeCode: type: string description: The facility type code of the original institutional claim. facilityType: type: string description: The facility type description. frequencyTypeCode: type: string description: The frequency type code of the original institutional claim. frequencyType: type: string description: The frequency type description. patientControlNumber: type: string description: The patient contorl number. pharmacyPrescriptionNumber: type: string description: The pharmacy prescription number. voucherNumber: type: string description: The payer assigned voucher identifier. claimIdentificationNumber: type: string description: The clearinghouse assigned trace number of the original claim. fromDate: type: string format: date description: The claim service from date. toDate: type: string format: date description: The claim service to date. statusDetails: type: array description: Reports the status, required action, and paid information of a claim. items: $ref: '#/definitions/ClaimStatusDetail' serviceLines: type: array description: Reports the status, required action, and paid information for a service line. items: $ref: '#/definitions/ServiceLine' ClaimStatusDetail: type: object properties: category: type: string description: The decode of the category of the claim status.") categoryCode: type: string description: The category code of the claim status.") status: type: string description: The decode of the status of the claim status.") statusCode: type: string description: The status code of the claim status.") entity: type: string description: The decode of the entity of the claim status.") entityCode: type: string description: The entity code of the claim status.") effectiveDate: type: string format: date description: The date this status was effective.") claimAmount: type: string description: The charge amount of the original claim.") claimAmountUnits: type: string description: The units describing the cliam amount.") paymentAmount: type: string description: The amount paid by the health plan from the original claim.") paymentAmountUnits: type: string description: The units describing the paid amount.") finalizedDate: type: string format: date description: The date the original claim was finalized/adjudicated.") remittanceDate: type: string format: date description: The date the original claim was paid by the health plan.") checkNumber: type: string description: The check or EFT Trace Number that paid the original claim.") ServiceLine: type: object properties: procedureQualifier: type: string description: Description of the product or service id qualifier. procedureQualifierCode: type: string description: The product or service qualifier code. procedure: type: string description: Description of the procedure performed. procedureCode: type: string description: The procedure code. modifier1: type: string description: Description of a modification related to the performance of the service. modifier1Code: type: string description: Identifier code of a modification related to the performance of the service. modifier2: type: string description: Description of a modification related to the performance of the service. modifier2Code: type: string description: Identifier code of a modification related to the performance of the service. modifier3: type: string description: Description of a modification related to the performance of the service. modifier3Code: type: string description: Identifier code of a modification related to the performance of the service. modifier4: type: string description: Description of a modification related to the performance of the service. modifier4Code: type: string description: Identifier code of a modification related to the performance of the service. chargeAmount: type: string description: The line item total on the current claim service status. chargeAmountUnits: type: string description: The units of the charge amount. paymentAmount: type: string description: The line item paid amount. paymentAmountUnits: type: string description: The units of the paid amount. service: type: string description: The description of a product or service. serviceCode: type: string description: The identifying number for a product or service. quantity: type: string description: The quantity of the product or service. controlNumber: type: string description: The service line control number. fromDate: type: string format: date description: The service line service from date. toDate: type: string format: date description: The service line service to date. statusDetails: type: array description: Reports the status, required action, and paid information of a claim or service line. items: $ref: '#/definitions/ClaimStatusDetail' 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. tags: [] x-ibm-endpoints: - endpointUrl: https://api.availity.com/availity description: Custom API Endpoint type: - production ...