--- swagger: "2.0" info: x-ibm-name: service-reviews title: Service Reviews version: 2.0.0 description: This resource represents a request to obtain authorization to perform a service or refer a patient to another provider. Your application can use the endpoints defined for it to find, create, and manage these requests. schemes: - https 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: false phase: realized paths: /service-reviews: get: summary: Initiate a new service review inquiery request or view an existing request. operationId: findServiceReviews produces: - application/json - application/xml parameters: - name: payer.id type: string in: query description: The Availity payer id of the member. - name: requestingProvider.specialtyCode type: string in: query description: The requesting provider's specialty code. - name: requestingProvider.lastName type: string in: query description: The requesting provider's last or business name. - name: requestingProvider.firstName type: string in: query description: The requesting provider's first name. - name: requestingProvider.middleName type: string in: query description: The requesting provider's middle name. - name: requestingProvider.suffix type: string in: query description: The requesting provider's suffix. - name: requestingProvider.npi type: string in: query description: The requesting provider's national provider id. - name: requestingProvider.taxId type: string in: query description: The requesting provider's tax id. - name: requestingProvider.payerAssignedProviderId type: string in: query description: The requesting provider's payer assigned provider id. - name: requestingProvider.submitterId type: string in: query description: The requesting provider's submitter id. - name: requestingProvider.addressLine1 type: string in: query description: The requesting provider's address. - name: requestingProvider.addressLine2 type: string in: query description: The requesting provider's address. - name: requestingProvider.city type: string in: query description: The requesting provider's city. - name: requestingProvider.stateCode type: string in: query description: The requesting provider's state code. - name: requestingProvider.zipCode type: string in: query description: The requesting provider's ZIP code. - name: requestingProvider.contactName type: string in: query description: The requesting provider's contact name. - name: requestingProvider.phone type: string in: query description: The requesting provider's phone. - name: requestingProvider.extension type: string in: query description: The requesting provider's extension. - name: requestingProvider.fax type: string in: query description: The requesting provider's fax. - name: subscriber.memberId type: string in: query description: The subcriber's member id. - name: subscriber.firstName type: string in: query description: The subcriber's first name. - name: subscriber.lastName type: string in: query description: The subcriber's last name. - name: subscriber.middleName type: string in: query description: The subcriber's middle name. - name: subscriber.suffix type: string in: query description: The subcriber'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.subscriberRelationshipCode type: string in: query description: The patient's relationship to subscriber code. - name: requestTypeCode type: string in: query description: The request type 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: certificationIssueDate type: string format: date in: query description: The certification issue date. - name: certificationNumber type: string in: query description: The certification number. - name: referenceNumber type: string in: query description: The reference number. - name: statusCode type: string in: query description: The status code. - name: sessionId type: string in: query description: The session id. responses: 200: description: OK schema: $ref: '#/definitions/ResultSet' 202: description: Accepted headers: Location: type: string description: Location of the service review inquiry. 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' post: summary: Create a new service review. operationId: createServiceReview consumes: - application/json - application/xml produces: - application/json - application/xml parameters: - in: body name: servicereview schema: $ref: '#/definitions/ServiceReview' responses: 202: description: Accepted headers: Location: type: string description: Location of the service review. X-Status-Message: type: string description: Current status of the pending request. 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' put: summary: Update a service review. operationId: updateServiceReview consumes: - application/json - application/xml produces: - application/json - application/xml parameters: - in: body name: servicereview schema: $ref: '#/definitions/ServiceReview' responses: 202: description: Accepted headers: Location: type: string description: Location of the service review. X-Status-Message: type: string description: Current status of the pending request. 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' /service-reviews/{id}: get: summary: Get the a service review by id. operationId: getServiceReviewById produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 200: description: OK schema: $ref: '#/definitions/ServiceReview' 202: description: Accepted headers: Location: type: string description: Location of the service review. X-Status-Message: type: string description: Current status of the pending request. 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: summary: Void a service review. operationId: voidServiceReview produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 202: description: Accepted headers: Location: type: string description: Location of the service review. X-Status-Message: type: string description: Current status of the pending request. 204: description: No Content 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' parameters: - name: id type: string required: true in: path description: A service review 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' serviceReviews: type: array description: list of service reviews items: $ref: '#/definitions/ServiceReview' Link: type: object properties: href: type: string description: The URL. ServiceReview: type: object properties: id: type: string description: The service review id. customerId: type: string description: The Availity Customer ID of the customer that owns this service review. controlNumber: type: string description: The control number of the X12 request that this service review was created from. userId: type: string description: The User ID of the customer that owns this service review. shortFormIndicator: type: boolean description: short form indicator updatable: type: boolean description: Indicates if this service review is updateable. deletable: type: boolean description: Indicates if this service review is deletable. updatableFields: type: array description: Updatable fields. items: type: string status: type: string description: The status of the service review. statusCode: type: string description: The status code of the service review. statusReasons: type: array description: Status reasons items: type: object properties: code: type: string description: Status reason code. value: type: string description: Status reason. createdDate: type: string format: date-time description: The date this coverage entry was created. updatedDate: type: string format: date-time description: The date when this coverage entry was last updated. expirationDate: type: string format: date-time description: The date when this coverage entry expires. validationMessages: type: array description: Messages after validation. items: $ref: '#/definitions/FieldError' providerNotes: type: array description: Notes from the provider. items: $ref: '#/definitions/Note' payerNotes: type: array description: Notes from the payer. items: $ref: '#/definitions/Note' payer: $ref: '#/definitions/Payer' requestingProvider: $ref: '#/definitions/RequestingProvider' subscriber: $ref: '#/definitions/Subscriber' patient: $ref: '#/definitions/Patient' diagnoses: type: array description: Diagnoses. items: $ref: '#/definitions/Diagnosis' certificationIssueDate: type: string format: date description: The date this service review was created. certificationEffectiveDate: type: string format: date description: The date this service review became effective. certificationExpirationDate: type: string format: date description: The date this service review expires. certificationNumber: type: string description: The service review number. referenceNumber: type: string description: The reference number. traceNumbers: type: array description: Trace numbers added to this Service Review by the payer. items: type: string requestType: type: string description: type of request. requestTypeCode: type: string description: request type code serviceType: type: string description: type of service. serviceTypeCode: type: string description: type code. additionalServiceTypes: type: array description: Additional service types. items: type: object properties: code: type: string description: Additional service type code. value: type: string description: Additional service type. placeOfService: type: string description: place of service. placeOfServiceCode: type: string description: place of service code. serviceLevel: type: string description: level of service. serviceLevelCode: type: string description: level of service code. fromDate: type: string format: date description: The date the service started. toDate: type: string format: date description: The date the service ended. quantity: type: string description: the quantity of the procedure. quantityType: type: string description: the unit of measure for quantity of the procedure. quantityTypeCode: type: string description: the code for the unit of measure for quantity of the procedure. admissionType: type: string description: the admission type. admissionTypeCode: type: string description: the admission type code. admissionSource: type: string description: the admission source. admissionSourceCode: type: string description: the admission source code. nursingHomeResidentialStatus: type: string description: The nursing home residential status. nursingHomeResidentialStatusCode: type: string description: The nursing home residential status code. homeHealthStartDate: type: string format: date description: The date the home health service started. homeHealthCertificationPeriodStartDate: type: string format: date description: The date the home health service started. homeHealthCertificationPeriodEndDate: type: string format: date description: The date the home health service started. transportType: type: string description: The type of medically related tranport. transportTypeCode: type: string description: The type code of medically related tranport. transportDistance: type: string description: The distance of medically related tranport. transportPurpose: type: string description: The purpose of medically related tranport. chiropracticTreatmentCount: type: string description: The chiropractic treatment count. beginningSubluxationLevel: type: string description: The beginning subluxation level. beginningSubluxationLevelCode: type: string description: The beginning subluxation level code. endingSubluxationLevel: type: string description: The ending subluxation level. endingSubluxationLevelCode: type: string description: The ending subluxation level code. spinalCondition: type: string description: The spinal condition. spinalConditionCode: type: string description: The spinal condition code. spinalConditionDescription: type: string description: A description of the spinal condition. oxygenEquipmentType: type: string description: The oxygen equipment type. oxygenEquipmentTypeCode: type: string description: The oxygen equipment type code. oxygenFlowRate: type: string description: The oxygen flow rate. oxygenDailyUseCount: type: string description: The oxygen daily use count. oxygenUsePeriodHourCount: type: string description: The oxygen use period hour count. oxygenOrderText: type: string description: The oxygen order text. oxygenDeliverySystemType: type: string description: The oxygen delivery system type. oxygenDeliverySystemTypeCode: type: string description: The oxygen delivery system type code. transportLocations: type: array description: The locations of medically related tranport. items: $ref: '#/definitions/TransportLocation' procedures: type: array description: The medical procedures to be performed. items: $ref: '#/definitions/Procedures' renderingProviders: type: array description: The rendering providers to perform the procedures. items: $ref: '#/definitions/RenderingProvider' supplementalInformation: $ref: '#/definitions/SupplementalInformation' Note: 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. Payer: type: object properties: id: type: string description: Service review payer id name: type: string description: Service review 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 url: type: string description: Website URL RequestingProvider: type: object properties: lastName: type: string description: The last name of an individual provider or the name of an organizational provider. 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 the provider. submitterId: type: string description: The payer assigned provider reference number. specialty: type: string description: The speciality of a provider. specialtyCode: type: string description: The speciality code of a provider. addressLine1: type: string description: The street line 1. addressLine2: type: string description: The street line 2. 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. contactName: type: string description: Full Name phone: type: string description: Phone Number extension: type: string description: Phone Extension fax: type: string description: Fax emailAddress: type: string description: E-mail Address url: type: string description: Website URL 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. addressLine1: type: string description: The street line 1. addressLine2: type: string description: The street line 2. 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. 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. 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. 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. addressLine1: type: string description: The street line 1. addressLine2: type: string description: The street line 2. 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. status: type: string description: The patient's status statusCode: type: string description: The patient's status code condition: type: string description: The condition conditionCode: type: string description: The condition code medicareCoverage: type: boolean description: The patient is covered by Medicare prognosis: type: string description: The prognosis prognosisCode: type: string description: The prognosis code Diagnosis: type: object properties: qualifier: type: string description: The qualifier for the diagnosis. qualifierCode: type: string description: The qualifier code for the diagnosis. value: type: string description: The value or description of the diagnosis. code: type: string description: The code for the diagnosis. date: type: string format: date description: The date the diagnosis was reached. TransportLocation: type: object properties: name: type: string description: The name of the transport location addressLine1: type: string description: The address line 1 of the transport location addressLine2: type: string description: The address line 2 of the transport location city: type: string description: The city of the transport location state: type: string description: The state of the transport location stateCode: type: string description: The state code of the transport location zipCode: type: string description: The ZIP code of the transport location Procedures: type: object properties: revenueValue: type: string description: for institutional procedure the revenue value of the procedure. revenueCode: type: string description: for institutional procedure the revenue code of the procedure. qualifier: type: string description: the qualifier for the procedure. qualifierCode: type: string description: the qualifier code for the procedure. value: type: string description: the value or description for the procedure. code: type: string description: the code for the procedure. modifier1: type: string description: modifier for the procedure modifierCode1: type: string description: modifier code for the procedure modifier2: type: string description: modifier for the procedure modifierCode2: type: string description: modifier code for the procedure modifier3: type: string description: modifier for the procedure modifierCode3: type: string description: modifier code for the procedure modifier4: type: string description: modifier for the procedure modifierCode4: type: string description: modifier code for the procedure description: type: string description: description of the procedure. quantity: type: string description: the quantity of the procedure. quantityType: type: string description: the unit of measure for quantity of the procedure. quantityTypeCode: type: string description: the code for the unit of measure for quantity of the procedure. fromDate: type: string format: date description: The date the procedure started. toDate: type: string format: date description: The date the procedure ended. status: type: string description: the status of the procedure. statusCode: type: string description: the status code of the procedure. statusReasons: type: array description: Status reasons items: type: object properties: code: type: string description: Status reason code. value: type: string description: Status reason. certificationIssueDate: type: string format: date description: The date the authorization was issued. certificationEffectiveDate: type: string format: date description: The date the authorization became effective. certificationExpirationDate: type: string format: date description: The date the authorization expired. certificationNumber: type: string description: the authorization number. traceNumbers: type: array description: Trace numbers added to this Service Review by the payer. items: type: string notes: type: array description: Notes, disclaimers, and descriptions. items: $ref: '#/definitions/Note' RenderingProvider: type: object properties: lastName: type: string description: The last name of an individual provider or the name of an organizational provider. 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. specialty: type: string description: The speciality of a provider. specialtyCode: type: string description: The speciality code of a provider. role: type: string description: The role of a provider. roleCode: type: string description: The role code of a provider. addressLine1: type: string description: The street line 1. addressLine2: type: string description: The street line 2. 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. contactName: type: string description: Full Name phone: type: string description: Phone Number extension: type: string description: Phone Extension fax: type: string description: fax emailAddress: type: string description: E-mail Address url: type: string description: Website URL SupplementalInformation: type: object properties: attachments: type: array description: The attachments information. items: $ref: '#/definitions/Attachment' diagnoses: type: array description: The diagnosis information. items: $ref: '#/definitions/Diagnosis' procedures: type: array description: The procedure information. items: $ref: '#/definitions/Diagnosis' refAuthNumber: type: string description: The authorization or referral number. sequence: type: string description: The sequence number. updateType: type: string description: The update type. Attachment: type: object properties: fileName: type: string description: The attachment file name. id: type: string description: The id number of the attachments. idType: type: string description: The id type for the attachment. dateReceived: type: string format: date description: The date the attachment info was received. 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. basePath: /v2 x-ibm-endpoints: - endpointUrl: https://api.availity.com/availity description: Custom API Endpoint type: - production ...