Remittance API

Submitted by katieaugustus on Tue, 05/28/2024 - 18:17

Remittance API overview

 

The Remittance API allows providers to search for and view electronic remittance advice (ERA) (also known as 835 data). This API gives trading partners secure access to ERAs that providers can review and maintain within billing software without requiring X12 connectivity. Users can search by check number or claim, and trading partners can convert the data to a PDF for easy downloading.

For more information about response fields and healthcare code sources, refer to the following ASC X12 Standards for Electronic Data Interchange Technical Report 3 (TR3): Health Care Claim Payment/Advice (835).

ERA enrollment

 

To use the Remittance API, you must enroll to receive electronic remittance advice (ERA) files through Availity Essentials. Follow these steps:

  1. In the Availity Essentials navigation menu, select More > Payer List.

  2. In the Search field, enter the full or partial payer name or payer ID and select Search.

  3. Select a payer name to expand and review transaction details. If the Remitance API is supported for a payer, you will see Available under REST API.

  4. If enrollment is required for the Claim Payment/Advice (835) transaction, select Enroll here in the Enrollment Required column on the payer’s card.

  5. On the Transaction Enrollment - Enrollment Status page, select Enroll > Enroll a provider to enroll for the Claim Payment/Advice (835) transaction.

Endpoints

 

 
PathFunction
1. POST/v2/Apic/searchChecksSearch for remittances by check/EFT information. Can return multiple results.
2. POST/v2/Apic/getFullCheckDataReturns a full JSON object that can be used to create a PDF version of the check/EFT. If your request returns multiple checks, you will need to add more information in your request body to narrow your results.
3. POST/v2/Apic/searchClaimsSearch for remittances by claim information. Can return multiple results.
4. POST/v2/Apic/getFullClaimDataReturns a full JSON object that can be used to create a PDF version of the claim. If your request returns multiple claims, you will need to add more information in your request body to narrow your results.

Parameters

 

1. POST/v2/Apic/searchChecks

 
POST/v2/Apic/searchChecks request body
ObjectTypeDefinition
checkNumberStringThe number of the check/EFT.
checkAmountStringThe monetary amount of the check/EFT.
taxIdString (Required)The provider's tax ID.
npiStringThe provider's National Provider Identifier.
organizationIdStringThe unique number that Availity uses to identify your organization.
payerIdStringThe payer's Availity-specific identifier.
checkDateFrom

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The beginning date range in which the check/EFT was issued.
checkDateTo

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The ending date range in which the check/EFT was issued.

2. POST/v2/Apic/getFullCheckData

 
POST/v2/Apic/getFullCheckData request body
ObjectTypeDefinition
checkNumberString (Required)The number of the check/EFT.
checkAmountStringThe monetary amount of the check/EFT.
taxIdString (Required)The provider's tax ID.
npiStringThe provider's National Provider Identifier.
organizationIdStringThe unique number that Availity uses to identify your organization.
payerIdStringThe payer's Availity-specific identifier.
checkDateFrom

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The beginning date range in which the check/EFT was issued.
checkDateTo

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The ending date range in which the check/EFT was issued.

3. POST/v2/Apic/searchClaims

 
POST/v2/Apic/searchClaims request body
ObjectTypeDefinition
claimNumberStringThe number identifying the claim.
serviceDateFromString (Date format: MM/DD/YYYY)The beginning date range for the services rendered in the claim.
serviceDateToString (Date format: MM/DD/YYYY)The beginning date range for the services rendered in the claim.
totalPaidAmountStringTotal monetary amount paid for the claim.
totalChargeAmountStringTotal monetary amount charged for the claim.
checkNumberStringThe number of the check/EFT.
checkAmountStringThe monetary amount of the check/EFT.
taxIdString (Required)The provider's tax ID.
npiStringThe provider's National Provider Identifier.
organizationIdStringThe unique number that Availity uses to identify your organization.
payerIdStringThe payer's Availity-specific identifier.
checkDateFrom

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The beginning date range in which the check/EFT was issued.
checkDateTo

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The ending date range in which the check/EFT was issued.

4. POST/v2/Apic/getFullClaimData

 
POST/v2/Apic/getFullClaimData request body
ObjectTypeDefinition
claimNumberString (Required)The number identifying the claim.
serviceDateFromString (Date format: MM/DD/YYYY)The beginning date range for the services rendered in the claim.
serviceDateToString (Date format: MM/DD/YYYY)The beginning date range for the services rendered in the claim.
totalPaidAmountStringTotal monetary amount paid for the claim.
totalChargeAmountStringTotal monetary amount charged for the claim.
checkNumberStringThe number of the check/EFT.
checkAmountStringThe monetary amount of the check/EFT.
taxIdString (Required)The provider's tax ID.
npiStringThe provider's National Provider Identifier.
organizationIdStringThe unique number that Availity uses to identify your organization.
payerIdStringThe payer's Availity-specific identifier.
checkDateFrom

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The beginning date range in which the check/EFT was issued.
checkDateTo

String

  • Required
  • Date format: MM/DD/YYYY
  • Date range limit: Two years

The ending date range in which the check/EFT was issued.

Sample requests and responses

 

1. POST/v2/Apic/searchChecks

Request:

curl --request POST \
  --url https://api.availity.com/availity/development-partner/localhost:7704/financial-clearinghouse/fch-remits-net/v2/Apic/searchChecks \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json' \
  --header 'content-type: application/json' \
  --data '{
  "checkNumber": "5357404778659840",
  "checkAmount": 70.52677949,
  "taxId": "7811608724111360",
  "npi": "pehid",
  "organizationId": "6908708900569088",
  "payerId": "783827536445440",
  "checkDateFrom": "2009-06-02T08:43:23.316Z",
  "checkDateTo": "2017-09-16T23:40:45.247Z"
}

Response:

{
  "edges": [
    {
      "cursor": "capj",
      "node": {
        "exchangeDate": "2010-05-15T06:24:31.630Z",
        "receiverId": "5661895868547072",
        "payerId": "1271135295504384",
        "availitySequence": "huhujdad",
        "customerId": "2356712629600256",
        "transactionId": "8814597572132864",
        "checkDate": "2001-01-08T05:38:41.615Z",
        "checkNumber": "6873998568718336",
        "claimNumber": "6398148924669952",
        "checkAmount": 63.97901867,
        "payerName": "Oscar Estrada",
        "payeeNpi": "rufgigw",
        "payerAssignedPayeeId": "2056117356068864",
        "payeeTaxId": "3393954735194112",
        "payeeName": "Lewis Steele",
        "totalClaimCount": 24978503,
        "exchangeFilename": "Connor Cummings",
        "hasExternalEOB": true,
        "isAutoDownload": true,
        "hasPLB": true,
        "reportTransmissionCd": "wushokihlawij",
        "reportTransmissionNm": "beniijihe",
        "reportCommunicationNum": "morwo",
        "id": "4667234184069120",
        "payerOtherId1": "5763745408090112",
        "functionalGrpSenderCd": "ekenafos",
        "clairId": "8162826197663744"
      }
    },
    {
      "cursor": "sihkusm",
      "node": {
        "exchangeDate": "2005-04-13T06:24:11.043Z",
        "receiverId": "3935840652754944",
        "payerId": "4060900904402944",
        "availitySequence": "agmivfosoj",
        "customerId": "3297284204789760",
        "transactionId": "466590206263296",
        "checkDate": "2020-02-27T16:46:10.627Z",
        "checkNumber": "670849000538112",
        "claimNumber": "1396533681455104",
        "checkAmount": 45.72607272,
        "payerName": "Ora Allen",
        "payeeNpi": "vacib",
        "payerAssignedPayeeId": "6876795041218560",
        "payeeTaxId": "409135499706368",
        "payeeName": "Bernard Lee",
        "totalClaimCount": 26725167,
        "exchangeFilename": "Phillip Logan",
        "hasExternalEOB": true,
        "isAutoDownload": true,
        "hasPLB": false,
        "reportTransmissionCd": "idafiwoiswe",
        "reportTransmissionNm": "taejviherkebpof",
        "reportCommunicationNum": "piawpovnanaimb",
        "id": "7791761575378944",
        "payerOtherId1": "7151436206964736",
        "functionalGrpSenderCd": "bavaggo",
        "clairId": "1610566045007872"
      }
    },
    {
      "cursor": "hejesju",
      "node": {
        "exchangeDate": "2001-03-26T07:01:43.011Z",
        "receiverId": "5755998849466368",
        "payerId": "8627972298768384",
        "availitySequence": "dakarmuhpokpa",
        "customerId": "4744509300670464",
        "transactionId": "3066717580296192",
        "checkDate": "2005-07-17T10:10:30.247Z",
        "checkNumber": "6562355276152832",
        "claimNumber": "3560717265403904",
        "checkAmount": 3.4858179,
        "payerName": "Beulah Norman",
        "payeeNpi": "cefi",
        "payerAssignedPayeeId": "4784314948517888",
        "payeeTaxId": "6358942844190720",
        "payeeName": "Martha Curry",
        "totalClaimCount": -43529516,
        "exchangeFilename": "Nora Ryan",
        "hasExternalEOB": true,
        "isAutoDownload": true,
        "hasPLB": true,
        "reportTransmissionCd": "calihisacmup",
        "reportTransmissionNm": "raddevcowoebhed",
        "reportCommunicationNum": "rulew",
        "id": "8533842853888000",
        "payerOtherId1": "1996953971851264",
        "functionalGrpSenderCd": "nogzagejih",
        "clairId": "1792331682414592"
      }
    }
  ],
  "pageInfo": {
    "hasNextPage": false,
    "hasPreviousPage": false,
    "startCursor": "pededegew",
    "endCursor": "gesou"
  },
  "totalCount": -23227469,
  "edgeCount": 19601619
}

2. POST/v2/Apic/getFullCheckData

Request:

curl --request POST \
  --url https://api.availity.com/availity/development-partner/localhost:7704/financial-clearinghouse/fch-remits-net/v2/Apic/getFullCheckData \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json' \
  --header 'content-type: application/json' \
  --data ''

Response:

Retrieve a sample response to POST/v2/Apic/getFullCheckData here: Remittance API Product Overview

Note: If your request returns data for more than one check/EFT, you will receive the following message:

Search returned multiple results. Please include more search criteria to reduce result set.

Add more information in your request body to narrow your results.

3. POST/v2/Apic/searchClaims

Request:

curl --request POST \
   --url https://api.availity.com/availity/development-partner/localhost:7704/financial-clearinghouse/fch-remits-net/v2/Apic/searchClaims \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json' \
  --header 'content-type: application/json' \
  --data '{
  "claimNumber": "3129446257131520",
  "serviceDateFrom": "2003-09-18T05:16:06.003Z",
  "serviceDateTo": "2007-07-29T09:47:51.265Z",
  "totalPaidAmount": 58.95381956,
  "totalChargeAmount": 52.45443848,
  "checkNumber": "5360890801029120",
  "checkAmount": 15.82551601,
  "taxId": "5865511051067392",
  "npi": "zuzcinrebuv",
  "organizationId": "2155983308587008",
  "payerId": "4143903322144768",
  "checkDateFrom": "2016-12-06T12:23:08.667Z",
  "checkDateTo": "2012-11-06T11:45:54.047Z"
}'

Response:

{
  "edges": [
    {
      "cursor": "juftong",
      "node": {
        "exchangeDate": "2003-03-11T20:34:57.072Z",
        "receiverId": "1253866236542976",
        "payerId": "6412202271571968",
        "availitySequence": "ahnurseziig",
        "commonSequence": 34145593,
        "claimAdjustmentGroupCodes": "dabupu",
        "serviceLineAdjustmentGroupCodes": "dokazoezm",
        "checkAmount": 45.69254445,
        "checkDate": "2001-08-28T19:04:36.294Z",
        "checkNumber": "6822812306112512",
        "claimControlNumber": "1968105792208896",
        "claimPaymentAmount": 10.08403974,
        "claimReceivedDate": "2017-08-12T07:48:32.599Z",
        "claimStatus": "robjahehlumteheh",
        "correctedFirstName": "Dora",
        "correctedFullName": "Mistry",
        "correctedPatientId": "3102833947705344",
        "correctedLastName": "Costantini",
        "correctedMiddleName": "David Ellis",
        "customerId": "1001620846411776",
        "claimStatementDateFrom": "2023-03-30T10:42:30.071Z",
        "serviceDateFrom": "2004-09-13T11:36:34.269Z",
        "patientAccountNumber": "4903140055856664",
        "patientFirstName": "Mable",
        "patientFullName": "Cunningham",
        "patientId": "7229537377058816",
        "patientIdTypeCode": "1164959677415424",
        "patientLastName": "Santoni",
        "patientMiddleName": "David Carpenter",
        "patientResponsibilityAmount": 97.98602027,
        "payeeName": "Lina Rowe",
        "payeeNPI": "pomg",
        "payerAssignedPayeeId": "5418203868037120",
        "payeeTaxId": "8613736166195200",
        "payerName": "Victor Jackson",
        "subscriberFirstName": "Ronnie",
        "subscriberFullName": "Barry",
        "subscriberId": "234177960083456",
        "subscriberIdTypeCode": "7689145564528640",
        "subscriberLastName": "Bernardi",
        "claimStatementDateTo": "2002-11-18T15:16:38.088Z",
        "serviceDateTo": "2016-08-17T14:04:54.414Z",
        "totalClaimAmount": 57.2865,
        "totalClaimChargeAmount": 47.83954425,
        "totalClaimCount": 82327280,
        "transactionId": "208432783163392",
        "hasExternalEOB": false,
        "isAutoDownload": true,
        "isBusinessScenarioOn": false,
        "id": "3548250573373440",
        "clairId": "7512165772689408"
      }
    },
    {
      "cursor": "vuwetoers",
      "node": {
        "exchangeDate": "2011-04-16T03:02:58.248Z",
        "receiverId": "2225590518153216",
        "payerId": "3754276264345600",
        "availitySequence": "arwugh",
        "commonSequence": -8987971,
        "claimAdjustmentGroupCodes": "lumemefizkati",
        "serviceLineAdjustmentGroupCodes": "bonuvd",
        "checkAmount": 74.36277787,
        "checkDate": "2016-05-17T16:55:23.191Z",
        "checkNumber": "8437846744498176",
        "claimControlNumber": "1636835304407040",
        "claimPaymentAmount": 18.75379756,
        "claimReceivedDate": "2000-05-16T22:22:23.685Z",
        "claimStatus": "waludegimrigwof",
        "correctedFirstName": "Lula",
        "correctedFullName": "Simons",
        "correctedPatientId": "7074461507387392",
        "correctedLastName": "Vazquez",
        "correctedMiddleName": "Bruce Moran",
        "customerId": "2218388008992768",
        "claimStatementDateFrom": "2007-04-05T06:14:07.698Z",
        "serviceDateFrom": "2024-01-19T03:06:02.494Z",
        "patientAccountNumber": "5481241762111547",
        "patientFirstName": "Cameron",
        "patientFullName": "Guasti",
        "patientId": "8168246777741312",
        "patientIdTypeCode": "1401893746114560",
        "patientLastName": "Parker",
        "patientMiddleName": "Jerry Bryant",
        "patientResponsibilityAmount": 63.78005892,
        "payeeName": "Ernest Watson",
        "payeeNPI": "adgewibhu",
        "payerAssignedPayeeId": "5661949257842688",
        "payeeTaxId": "8385453608665088",
        "payerName": "Mattie Ryan",
        "subscriberFirstName": "Jesus",
        "subscriberFullName": "Castro",
        "subscriberId": "4500785492656128",
        "subscriberIdTypeCode": "1480649024208896",
        "subscriberLastName": "Calvelli",
        "claimStatementDateTo": "2014-10-03T00:13:40.956Z",
        "serviceDateTo": "2013-10-17T18:41:56.700Z",
        "totalClaimAmount": 53.57959936,
        "totalClaimChargeAmount": 16.35286645,
        "totalClaimCount": -32510864,
        "transactionId": "6484498969526272",
        "hasExternalEOB": true,
        "isAutoDownload": false,
        "isBusinessScenarioOn": true,
        "id": "1468479777538048",
        "clairId": "6961536180420608"
      }
    },
    {
      "cursor": "sotnepiiheka",
      "node": {
        "exchangeDate": "2021-08-01T09:09:13.889Z",
        "receiverId": "2271812262035456",
        "payerId": "6066312059027456",
        "availitySequence": "pabw",
        "commonSequence": -50754880,
        "claimAdjustmentGroupCodes": "suhokeveipafek",
        "serviceLineAdjustmentGroupCodes": "geivboolcuvh",
        "checkAmount": 32.067892,
        "checkDate": "2021-05-29T18:33:09.479Z",
        "checkNumber": "1567060754694144",
        "claimControlNumber": "2612301033111552",
        "claimPaymentAmount": 90.97055339,
        "claimReceivedDate": "2007-12-11T11:51:05.477Z",
        "claimStatus": "wobirsuag",
        "correctedFirstName": "Addie",
        "correctedFullName": "Papucci",
        "correctedPatientId": "3364741112135680",
        "correctedLastName": "Blair",
        "correctedMiddleName": "Carlos Perkins",
        "customerId": "5280014960427008",
        "claimStatementDateFrom": "2022-09-26T05:23:18.666Z",
        "serviceDateFrom": "2005-03-06T12:40:09.525Z",
        "patientAccountNumber": "6372099422216258",
        "patientFirstName": "Luis",
        "patientFullName": "Duval",
        "patientId": "1174434117320704",
        "patientIdTypeCode": "2970468300619776",
        "patientLastName": "Gianni",
        "patientMiddleName": "Clara Fleming",
        "patientResponsibilityAmount": 57.28619271,
        "payeeName": "Billy Reynolds",
        "payeeNPI": "avoh",
        "payerAssignedPayeeId": "5642485910994944",
        "payeeTaxId": "7527015391428608",
        "payerName": "Miguel Wilson",
        "subscriberFirstName": "Edgar",
        "subscriberFullName": "Hicks",
        "subscriberId": "6603227428552704",
        "subscriberIdTypeCode": "8230856095170560",
        "subscriberLastName": "Perez",
        "claimStatementDateTo": "2008-02-26T02:29:21.309Z",
        "serviceDateTo": "2021-02-06T23:33:02.433Z",
        "totalClaimAmount": 94.15100825,
        "totalClaimChargeAmount": 34.99376727,
        "totalClaimCount": 84509842,
        "transactionId": "6942040277385216",
        "hasExternalEOB": true,
        "isAutoDownload": false,
        "isBusinessScenarioOn": false,
        "id": "2498803972177920",
        "clairId": "6852436983545856"
      }
    }
  ],
  "pageInfo": {
    "hasNextPage": false,
    "hasPreviousPage": false,
    "startCursor": "futbakd",
    "endCursor": "kidifojomo"
  },
  "totalCount": 29870982,
  "edgeCount": -48554902
}

4. POST/v2/Apic/getFullClaimData

Request:

curl --request POST \
  --url https://api.availity.com/availity/development-partner/localhost:7704/financial-clearinghouse/fch-remits-net/v2/Apic/getFullClaimData \
  --header 'Authorization: Bearer REPLACE_BEARER_TOKEN' \
  --header 'accept: application/json' \
  --header 'content-type: application/json' \
  --data '{
  "claimNumber": "2247077723635712",
  "serviceDateFrom": "2008-07-11T13:59:51.195Z",
  "serviceDateTo": "2015-11-11T14:00:42.069Z",
  "totalPaidAmount": 56.0970112,
  "totalChargeAmount": 64.16935895,
  "checkNumber": "7459825866768384",
  "checkAmount": 34.88463037,
  "taxId": "6939632824483840",
  "npi": "kewal",
  "organizationId": "3693479655899136",
  "payerId": "395909598806016",
  "checkDateFrom": "2007-07-14T20:26:48.530Z",
  "checkDateTo": "2012-12-19T16:17:42.647Z"
}'

Response:

Retrieve a sample response to POST/v2/Apic/getFullClaimData here: Remittance API Product Overview

Note: If your request returns data for more than one claim, you will receive the following message:

Search returned multiple results. Please include more search criteria to reduce result set.

Add more information in your request body to narrow your results.