production
https://api.availity.com/availity
Custom API Endpoint
Paths
/claim-statuses
get /claim-statuses
Initiate a new claim status request or view an existing request.
oauth2
oauth2
(oauth2 application)
Token URL
https://api.availity.com/v1/token
Scopes
hipaa
Realtime - Live HIPAA API
payer.id
Optional in query
string
The Availity payer id of the member.
submitter.lastName
Optional in query
string
The submitter's last or business name.
submitter.firstName
Optional in query
string
The submitter's first name.
submitter.middleName
Optional in query
string
The submitter's middle name.
submitter.suffix
Optional in query
string
The submitter's suffix.
submitter.id
Optional in query
string
The submitter's id.
providers.lastName
Optional in query
string
The provider's last name.
providers.firstName
Optional in query
string
The provider's first name.
providers.middleName
Optional in query
string
The provider's middle name.
providers.suffix
Optional in query
string
The provider's suffix.
providers.npi
Optional in query
string
The provider's national provider id.
providers.taxId
Optional in query
string
The provider's tax id.
providers.payerAssignedProviderId
Optional in query
string
The provider's payer assigned provider id.
subscriber.memberId
Optional in query
string
The subscriber's member id.
subscriber.lastName
Optional in query
string
The subscriber's last name.
subscriber.firstName
Optional in query
string
The subscriber's first name.
subscriber.middleName
Optional in query
string
The subscriber's middle name.
subscriber.suffix
Optional in query
string
The subscriber's suffix.
patient.lastName
Optional in query
string
The patient's last name.
patient.firstName
Optional in query
string
The patient's first name.
patient.middleName
Optional in query
string
The patient's middle name.
patient.suffix
Optional in query
string
The patient's suffix.
patient.birthDate
Optional in query
string / date
The patient's birth date.
patient.genderCode
Optional in query
string
The patient's gender code.
patient.accountNumber
Optional in query
string
The patient's account number.
patient.subscriberRelationshipCode
Optional in query
string
The patient's relationship to subscriber code.
fromDate
Optional in query
string / date
The service from date.
toDate
Optional in query
string / date
The service to date.
claimNumber
Optional in query
string
The health plan's claim tracking number assigned when the original claim was received and processed.
claimAmount
Optional in query
string
The total claim charge amount of the original claim processed by the health plan.
facilityTypeCode
Optional in query
string
The code identifying where services were, or may have been, performed for institutional claims.
frequencyTypeCode
Optional in query
string
The code identifying the frequency of an institutional claim.
Accept
Optional in header
string
application/json
application/xml
application/xml
200
OK
202
Accepted
400
Bad Request
401
Not Authorized
403
Forbidden
500
Internal Server Error
Example Request
Example Response
GET https://api.availity.com/availity/v1/claim-statuses
Try this operation
/claim-statuses/{id}
get /claim-statuses/{id}
Get the full claim status information by id.
oauth2
oauth2
(oauth2 application)
Token URL
https://api.availity.com/v1/token
Scopes
hipaa
Realtime - Live HIPAA API
id
Required in path
string
Accept
Optional in header
string
application/json
application/xml
application/xml
200
OK
202
Accepted
400
Bad Request
401
Not Authorized
403
Forbidden
404
Not Found
500
Internal Server Error
Example Request
Example Response
GET https://api.availity.com/availity/v1/claim-statuses/{id}
Try this operation
delete /claim-statuses/{id}
oauth2
oauth2
(oauth2 application)
Token URL
https://api.availity.com/v1/token
Scopes
hipaa
Realtime - Live HIPAA API
id
Required in path
string
A claim status id
Accept
Optional in header
string
application/xml
application/json
application/json
200
200 OK
Example Request
Example Response
DELETE https://api.availity.com/availity/v1/claim-statuses/{id}
Try this operation
Definitions
{
"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"
}
}
}
}
{
"type": "object",
"properties": {
"href": {
"type": "string",
"description": "The URL."
}
}
}
{
"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."
}
}
}
{
"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."
}
}
}
{
"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"
}
}
}
{
"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": {
"$ref": "#\/definitions\/ClaimStatusDetail"
}
},
"traceId": {
"type": "string",
"description": "Referenced transaction trace identifier."
}
}
}
{
"type": "object",
"properties": {
"lastName": {
"type": "string",
"description": "The last name of an individual or the name of an organization that provided services on the original claim."
},
"firstName": {
"type": "string",
"description": "The first name of an individual provider."
},
"middleName": {
"type": "string",
"description": "The middle name of an individual provider."
},
"suffix": {
"type": "string",
"description": "The suffix of an individual provider."
},
"npi": {
"type": "string",
"description": "The NPI of a provider."
},
"taxId": {
"type": "string",
"description": "The tax id of a provider."
},
"payerAssignedProviderId": {
"type": "string",
"description": "The payer assigned provider id of a provider."
},
"statusDetails": {
"type": "array",
"description": "Reports the status, required action, and paid information of a claim or service line.",
"items": {
"$ref": "#\/definitions\/ClaimStatusDetail"
}
},
"traceId": {
"type": "string",
"description": "Referenced transaction trace identifier."
}
}
}
{
"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."
}
}
}
{
"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."
}
}
}
{
"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"
}
}
}
}
{
"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.\")"
}
}
}
{
"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": {
"$ref": "#\/definitions\/ClaimStatusDetail"
}
}
}
}
{
"type": "object",
"properties": {
"userMessage": {
"type": "string",
"description": "A high level error message."
},
"developerMessage": {
"type": "string",
"description": "A more technical error message."
},
"reasonCode": {
"type": "integer",
"description": "A reason code."
},
"statusCode": {
"type": "integer",
"description": "The status code."
},
"errors": {
"type": "array",
"description": "A list of detailed user friendly messages.",
"items": {
"$ref": "#\/definitions\/FieldError"
}
}
}
}
{
"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."
}
}
}