production
https://api.availity.com/availity
Custom API Endpoint
Paths
/institutional-claims
post /institutional-claims
Create a new institutional claims.
oauth2
oauth2
(oauth2 application)
Token URL
https://api.availity.com/v1/token
Scopes
hipaa
Realtime - Live HIPAA API
institutionalclaim
Optional in body
object
Content-Type
Optional in header
string
application/json
application/xml
application/xml
Accept
Optional in header
string
application/json
application/xml
application/xml
202
Accepted
400
Bad Request
401
Not Authorized
403
Forbidden
500
Internal Server Error
Example Request
Example Response
POST https://api.availity.com/availity/v1/institutional-claims
/institutional-claims/{id}
get /institutional-claims/{id}
Get a institutional claim by its 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
202
Accepted
400
Bad Request
401
Not Authorized
403
Forbidden
404
Not Found
500
Internal Server Error
504
Gateway Timeout
Example Request
Example Response
GET https://api.availity.com/availity/v1/institutional-claims/{id}
Definitions
{
"type": "object",
"properties": {
"id": {
"type": "string",
"description": "The id of the institutional claim."
},
"createdDate": {
"type": "string",
"format": "date-time",
"description": "The date and time that this institutional claim was created."
},
"updatedDate": {
"type": "string",
"format": "date-time",
"description": "The date and time that this institutional claim was last updated."
},
"expirationDate": {
"type": "string",
"format": "date-time",
"description": "The date and time that this institutional claim will expire from our system."
},
"customerId": {
"type": "string",
"description": "The id of the customer that owns this institutional claim."
},
"requestTypeCode": {
"type": "string",
"description": "The type of institutional claim.",
"enum": [
"PRE_DETERMINATION"
]
},
"submitter": {
"type": "object",
"description": "The submitter.",
"properties": {
"lastName": {
"type": "string",
"description": "The last name of the submitter."
},
"firstName": {
"type": "string",
"description": "The first name of the submitter."
},
"middleName": {
"type": "string",
"description": "The middle name of the submitter."
},
"id": {
"type": "string",
"description": "The id of the submitter."
},
"contactName": {
"type": "string",
"description": "The contact name of the submitter."
},
"phone": {
"type": "string",
"description": "The phone number of the submitter."
},
"extension": {
"type": "string",
"description": "The phone number extension of the submitter."
},
"fax": {
"type": "string",
"description": "The fax number of the submitter."
},
"email": {
"type": "string",
"description": "The email address of the submitter."
}
}
},
"payer": {
"type": "object",
"description": "The payer.",
"properties": {
"name": {
"type": "string",
"description": "The name of the payer."
},
"id": {
"type": "string",
"description": "The id of the payer."
},
"addressLine1": {
"type": "string",
"description": "The address of the payer."
},
"addressLine2": {
"type": "string",
"description": "The address of the payer."
},
"city": {
"type": "string",
"description": "The city of the payer."
},
"stateCode": {
"type": "string",
"description": "The state code of the payer."
},
"zipCode": {
"type": "string",
"description": "The ZIP code of the payer."
},
"countryCode": {
"type": "string",
"description": "The country code of the payer.",
"enum": [
"US",
"CA"
]
},
"ein": {
"type": "string",
"description": "The EIN of the payer."
},
"claimOfficeNumber": {
"type": "string",
"description": "The claim office number of the payer."
},
"naicCode": {
"type": "string",
"description": "The NAIC code of the payer."
},
"responsibilitySequenceCode": {
"type": "string",
"description": "The responsibility sequence code of the payer.",
"enum": [
"P",
"S",
"T"
]
},
"insuranceTypeCode": {
"type": "string",
"description": "The insurance type code of the payer."
},
"claimFilingIndicatorCode": {
"type": "string",
"description": "The claim filing indicator code of the payer."
},
"disclaimer": {
"type": "string",
"description": "A disclaimer from the payer."
}
}
},
"billingProvider": {
"type": "object",
"description": "The billing provider.",
"properties": {
"specialtyCode": {
"type": "string",
"description": "The specialty code of the billing provider."
},
"name": {
"type": "string",
"description": "The name of the billing provider."
},
"npi": {
"type": "string",
"description": "The national provider id of the billing provider."
},
"addressLine1": {
"type": "string",
"description": "The address of the billing provider."
},
"addressLine2": {
"type": "string",
"description": "The address of the billing provider."
},
"city": {
"type": "string",
"description": "The city of the billing provider."
},
"stateCode": {
"type": "string",
"description": "The state code of the billing provider."
},
"zipCode": {
"type": "string",
"description": "The ZIP code of the billing provider."
},
"countryCode": {
"type": "string",
"description": "The country code of the billing provider.",
"enum": [
"US",
"CA"
]
},
"ein": {
"type": "string",
"description": "The EIN of the billing provider."
},
"ssn": {
"type": "string",
"description": "The SSN of the billing provider."
},
"stateLicenseNumber": {
"type": "string",
"description": "The state license number of the billing provider."
},
"payerAssignedProviderId": {
"type": "string",
"description": "The payer assigned provider id of the billing provider."
},
"contactName": {
"type": "string",
"description": "The contact name of the billing provider."
},
"phone": {
"type": "string",
"description": "The phone number of the billing provider."
},
"extension": {
"type": "string",
"description": "The phone number extension of the billing provider."
},
"fax": {
"type": "string",
"description": "The fax number of the billing provider."
},
"email": {
"type": "string",
"description": "The email address of the billing provider."
},
"payToAddress": {
"type": "object",
"description": "The pay to address of the billing provider.",
"properties": {
"addressLine1": {
"type": "string",
"description": "The address of the pay to address."
},
"addressLine2": {
"type": "string",
"description": "The address of the pay to address."
},
"city": {
"type": "string",
"description": "The city of the pay to address."
},
"stateCode": {
"type": "string",
"description": "The state code of the pay to address."
},
"zipCode": {
"type": "string",
"description": "The ZIP code of the pay to address."
}
}
}
}
},
"subscriber": {
"type": "object",
"description": "The subscriber.",
"properties": {
"lastName": {
"type": "string",
"description": "The last name of the subscriber."
},
"firstName": {
"type": "string",
"description": "The first name of the subscriber."
},
"middleName": {
"type": "string",
"description": "The middle name of the subscriber."
},
"suffix": {
"type": "string",
"description": "The suffix of the subscriber."
},
"memberId": {
"type": "string",
"description": "The member id of the subscriber."
},
"groupNumber": {
"type": "string",
"description": "The group number of the subscriber."
},
"groupName": {
"type": "string",
"description": "The group name of the subscriber."
},
"ssn": {
"type": "string",
"description": "The SSN of the subscriber."
},
"totalFamilyDeductible": {
"type": "string",
"description": "The total family deductible of the subscriber."
},
"accumulatedFamilyDeductible": {
"type": "string",
"description": "The accumulated family deductible of the subscriber."
},
"remainingFamilyDeductible": {
"type": "string",
"description": "The remaining family deductible of the subscriber."
},
"totalDeductible": {
"type": "string",
"description": "The total deductible of the subscriber."
},
"accumulatedDeductible": {
"type": "string",
"description": "The accumulated deductible of the subscriber."
},
"remainingDeductible": {
"type": "string",
"description": "The remaining deductible of the subscriber."
},
"onHold": {
"type": "boolean",
"description": "The subscriber's on hold indicator."
},
"holdReasons": {
"type": "array",
"description": "A list of hold reasons.",
"items": {
"$ref": "#/definitions/ItemDescription"
}
}
}
},
"patient": {
"type": "object",
"description": "The patient.",
"properties": {
"lastName": {
"type": "string",
"description": "The last name of the patient."
},
"firstName": {
"type": "string",
"description": "The first name of the patient."
},
"middleName": {
"type": "string",
"description": "The middle name of the patient."
},
"suffix": {
"type": "string",
"description": "The suffix of the patient."
},
"ssn": {
"type": "string",
"description": "The SSN of the patient."
},
"addressLine1": {
"type": "string",
"description": "The address of the patient."
},
"addressLine2": {
"type": "string",
"description": "The address of the patient."
},
"city": {
"type": "string",
"description": "The city of the patient."
},
"stateCode": {
"type": "string",
"description": "The state code of the patient."
},
"zipCode": {
"type": "string",
"description": "The ZIP code of the patient."
},
"birthDate": {
"type": "string",
"format": "date",
"description": "The birth date of the patient."
},
"gender": {
"type": "string",
"description": "The gender of the patient.",
"enum": [
"Female",
"Male",
"Unknown"
]
},
"genderCode": {
"type": "string",
"description": "The gender code of the patient.",
"enum": [
"F",
"M",
"U"
]
},
"subscriberRelationship": {
"type": "string",
"description": "The relationship of the patient to the subscriber.",
"enum": [
"Self",
"Spouse",
"Child",
"Employee",
"Unknown",
"Organ Donor",
"Cadaver Donor",
"Life Partner",
"Other Relationship",
"Other Adult"
]
},
"subscriberRelationshipCode": {
"type": "string",
"description": "The relationship code of the patient to the subscriber.",
"enum": [
18,
1,
19,
20,
21,
39,
40,
53,
"G8",
34
]
}
}
},
"claimInformation": {
"type": "object",
"description": "The claim information.",
"properties": {
"controlNumber": {
"type": "string",
"description": "The institutional claim's control number."
},
"facilityTypeCode": {
"type": "string",
"description": "The facility type code."
},
"frequencyTypeCode": {
"type": "string",
"description": "The frequency type code."
},
"providerAcceptAssignmentCode": {
"type": "string",
"description": "The provider accept assignment code."
},
"benefitsAssignmentCertification": {
"type": "boolean",
"description": "The benefits assignment certification indicator."
},
"informationReleaseCode": {
"type": "string",
"description": "The information release code."
},
"admissionTypeCode": {
"type": "string",
"description": "The admission type code."
},
"admissionSourceCode": {
"type": "string",
"description": "The admission source code."
},
"patientStatusCode": {
"type": "string",
"description": "The patient status code."
},
"bundled": {
"type": "boolean",
"description": "The bundled indicator."
},
"messages": {
"type": "array",
"description": "A list of messages from the payer.",
"items": {
"$ref": "#/definitions/ItemDescription"
}
},
"specialMessages": {
"type": "array",
"description": "A list of special messages from the payer.",
"items": {
"$ref": "#/definitions/ItemDescription"
}
},
"displayMessage": {
"type": "string",
"description": "A display message from the payer."
},
"serviceTypeCode": {
"type": "string",
"description": "The service type code."
},
"occurrenceCode": {
"type": "string",
"description": "The occurrence code."
},
"occurrenceCodeDate": {
"type": "string",
"format": "date",
"description": "The occurrence code date."
},
"valueCode": {
"type": "string",
"description": "The value code."
},
"valueCodeAmount": {
"type": "string",
"description": "The value code amount."
},
"conditionCode": {
"type": "string",
"description": "The condition code."
},
"claimIdentifier": {
"type": "string",
"description": "The claim identifier."
},
"principalDiagnosis": {
"$ref": "#/definitions/Diagnosis"
},
"admittingDiagnosis": {
"$ref": "#/definitions/Diagnosis"
},
"patientsReasonForVisit": {
"$ref": "#/definitions/Diagnosis"
},
"principalProcedure": {
"$ref": "#/definitions/Procedure"
},
"diagnosisRelatedGroupCode": {
"type": "string",
"description": "The diagnosis related group code."
},
"otherDiagnoses": {
"type": "array",
"description": "A list of other diagnoses.",
"items": {
"$ref": "#/definitions/Diagnosis"
}
},
"otherProcedures": {
"type": "array",
"description": "A list of other procedures.",
"items": {
"$ref": "#/definitions/Procedure"
}
},
"serviceLines": {
"type": "array",
"description": "A list of service lines.",
"items": {
"type": "object",
"properties": {
"controlNumber": {
"type": "string",
"description": "The service line's control number."
},
"fromDate": {
"type": "string",
"format": "date",
"description": "The service from date."
},
"toDate": {
"type": "string",
"format": "date",
"description": "The service to date."
},
"revenue": {
"type": "string",
"description": "The revenue description."
},
"revenueCode": {
"type": "string",
"description": "The revenue code."
},
"procedure": {
"type": "string",
"description": "The procedure description."
},
"procedureCode": {
"type": "string",
"description": "The procedure code."
},
"alternateProcedure": {
"type": "string",
"description": "Alternate procedure."
},
"modifierCode1": {
"type": "string",
"description": "The first procedure modifier."
},
"modifierCode2": {
"type": "string",
"description": "The second procedure modifier."
},
"modifierCode3": {
"type": "string",
"description": "The third procedure modifier."
},
"modifierCode4": {
"type": "string",
"description": "The fourth procedure modifier."
},
"amount": {
"type": "string",
"description": "The service charge amount."
},
"quantity": {
"type": "string",
"description": "The service quantity."
},
"quantityTypeCode": {
"type": "string",
"description": "The service quantity type code."
},
"estimatedPatientResponsibility": {
"type": "string",
"description": "The estimated patient responsibility."
},
"bundlingDescription": {
"type": "string",
"description": "A bundling description."
},
"denyReason": {
"type": "string",
"description": "The deny reason."
},
"holdReasons": {
"type": "array",
"description": "A list of hold reasons for this service line.",
"items": {
"$ref": "#/definitions/ItemDescription"
}
},
"messages": {
"type": "array",
"description": "A list of messages for this service line.",
"items": {
"$ref": "#/definitions/ItemDescription"
}
},
"displayMessage": {
"type": "string",
"description": "A display message."
},
"allowed": {
"$ref": "#/definitions/ItemDescription"
},
"estimated": {
"$ref": "#/definitions/ItemDescription"
},
"notCovered": {
"$ref": "#/definitions/ItemDescription"
},
"coPay": {
"$ref": "#/definitions/ItemDescription"
},
"coInsurance": {
"$ref": "#/definitions/ItemDescription"
},
"deductible": {
"$ref": "#/definitions/ItemDescription"
},
"contractual": {
"$ref": "#/definitions/ItemDescription"
},
"providerInitiated": {
"$ref": "#/definitions/ItemDescription"
},
"providerResponsibility": {
"$ref": "#/definitions/ItemDescription"
},
"remarks": {
"type": "array",
"description": "Remarks about this service line.",
"items": {
"type": "object",
"properties": {
"remarkCode": {
"type": "string",
"description": "The remark code."
},
"description": {
"type": "string",
"description": "The description."
}
}
}
}
}
}
},
"totalCharges": {
"$ref": "#/definitions/ItemDescription"
},
"totalAllowed": {
"$ref": "#/definitions/ItemDescription"
},
"totalEstimated": {
"$ref": "#/definitions/ItemDescription"
},
"totalNotCovered": {
"$ref": "#/definitions/ItemDescription"
},
"totalCoPay": {
"$ref": "#/definitions/ItemDescription"
},
"totalCoInsurance": {
"$ref": "#/definitions/ItemDescription"
},
"totalDeductible": {
"$ref": "#/definitions/ItemDescription"
},
"totalContractual": {
"$ref": "#/definitions/ItemDescription"
},
"totalProviderInitiated": {
"$ref": "#/definitions/ItemDescription"
},
"totalProviderResponsibility": {
"$ref": "#/definitions/ItemDescription"
},
"totalPatientLiability": {
"$ref": "#/definitions/ItemDescription"
},
"attendingProvider": {
"type": "object",
"description": "The attending provider.",
"properties": {
"lastName": {
"type": "string",
"description": "The attending provider's last name."
},
"firstName": {
"type": "string",
"description": "The attending provider's first name."
},
"npi": {
"type": "string",
"description": "The attending provider's national provider id."
}
}
}
}
},
"payerSpecificFlags": {
"type": "array",
"description": "A list of payer specific flags on this institutional claim.",
"items": {
"type": "object",
"properties": {
"name": {
"type": "string",
"description": "A payer specific flag name."
},
"value": {
"type": "string",
"description": "A payer specific flag value."
}
}
}
}
}
}
{
"type": "object",
"properties": {
"amount": {
"type": "string",
"description": "An amount."
},
"code": {
"type": "string",
"description": "A code."
},
"codeType": {
"type": "string",
"description": "A code type."
},
"description": {
"type": "string",
"description": "A description."
},
"procedure": {
"type": "string",
"description": "The procedure."
},
"patientLiable": {
"type": "boolean",
"description": "Indicates whether the patient is liable for the item."
}
}
}
{
"type": "object",
"properties": {
"qualifier": {
"type": "string",
"description": "The qualifier description."
},
"qualifierCode": {
"type": "string",
"description": "The qualifier code."
},
"code": {
"type": "string",
"description": "The diagnosis code."
},
"description": {
"type": "string",
"description": "The diagnosis description."
},
"presentOnAdmissionIndicatorCode": {
"type": "string",
"description": "The present on admission indicator code."
}
}
}
{
"type": "object",
"properties": {
"qualifier": {
"type": "string",
"description": "The qualifier description."
},
"qualifierCode": {
"type": "string",
"description": "The qualifier code."
},
"code": {
"type": "string",
"description": "The procedure code."
},
"description": {
"type": "string",
"description": "The procedure description."
},
"codeDate": {
"type": "string",
"format": "date",
"description": "The code date."
}
}
}
{
"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."
}
}
}