availity
Availity is a healthcare information network and clearinghouse providing REST APIs for real-time HIPAA EDI transactions. The platform processes over 11 billion annual healthcare transactions connecting providers, health plans, and vendors nationwide. Create your application and subscribe to a plan to make use of Availity APIs for eligibility verification, claims management, prior authorization, and patient cost estimation.
APIs
Availity Eligibility & Benefits API
The Availity Eligibility & Benefits API supports the ASC X12N 270 and 271 transactions, enabling real-time verification of member coverage, co-pays, deductibles, and benefits in...
Availity Claim Status API
The Availity Claim Status API enables the standard ASC X12N 276 and 277 transactions, allowing providers to find, create, and manage claim status inquiries against payer systems...
Availity Claim Attachments API
The Availity Claim Attachments API enables electronic submission of supporting documentation alongside healthcare claims. REST APIs support structured and unstructured attachmen...
Availity Service Reviews (Prior Authorization) API
The Availity Service Reviews API enables the ASC X12N 278 transaction for prior authorization and healthcare service review. REST APIs allow providers to find, create, and manag...
Availity Healthcare HIPAA Transactions API
The Availity Healthcare HIPAA Transactions API provides a unified interface for standard HIPAA EDI transactions. REST APIs enable healthcare providers and vendors to submit and ...
Availity Patient Cost Estimator API
The Availity Patient Cost Estimator API enables healthcare providers and institutions to estimate service costs before delivery for both institutional and professional services....
Availity Eligibility & Benefits Value-Add APIs
The Availity Eligibility & Benefits Value-Add APIs provide supplementary data during eligibility transactions. The Care Reminders API retrieves real-time care gap information fr...
Availity Payer List API
The Availity Payer List API (v1.0.4) allows healthcare organizations to query available payers and the transactions they support. Returns payer identifiers, names, and supported...
Availity Configurations API
The Availity Configurations API (v1.0.0) provides provider details and payer-specific validation requirements. Returns configuration rules for enhanced claim status, prior autho...
Capabilities
Availity Healthcare Revenue Cycle Management
Unified workflow for revenue cycle management combining eligibility verification, claim status tracking, and prior authorization. Used by billing departments and revenue cycle t...
Run with NaftikoFeatures
Client credentials grant flow with 5-minute token expiration and HTTPS/TLS encryption for secure API access.
Processing over 8.8 million daily transactions and 11 billion annual healthcare transactions across all major health plans.
Access to every major health plan nationwide and over 1 million providers through the Availity clearinghouse.
Returns JSON and XML representations including errors using HTTP response codes. Supports CSV, PDF, PNG, and XLS for specific endpoints.
Collection resources support offset/limit pagination with limit range of 1-50 items per request with link relations.
Demo subscriptions support custom response selection via X-Api-Mock-Scenario-ID and X-Api-Mock-Response headers.
Standard tier provides 100,000 calls per day and 100 calls per second for HIPAA transaction APIs.
Full support for HIPAA EDI version 005010 transactions including 270/271, 276/277, 278, and 835 transaction sets.
Use Cases
Verify patient insurance coverage, co-pays, deductibles, and benefits in real time before scheduling or rendering services.
Track submitted claims through adjudication, checking ACKNOWLEDGED, PENDING, PAID, DENIED, and ADJUSTED statuses.
Submit and track prior authorization requests using X12 278 transactions to check if authorization is required before service delivery.
Estimate patient out-of-pocket costs before services are rendered to meet price transparency requirements and inform patients.
Electronically attach clinical documentation to claims and authorizations, reducing manual faxing and accelerating adjudication.
Retrieve real-time care reminders during eligibility checks to identify preventive care gaps and coordinate outreach.
Retrieve member ID cards digitally during eligibility verification, reducing administrative burden and improving patient experience.
Connect to all major payers through a single clearinghouse API rather than managing individual payer connections.
Integrations
Integrates with electronic health record systems to embed eligibility and claims workflows into clinical workflows.
Connects practice management software to payer networks for revenue cycle management and claims processing.
Integrates with RCM platforms to automate eligibility verification, claim submission, and payment reconciliation.
Direct integration with BCBS plans nationwide for eligibility, claims, and prior authorization transactions.
Integration with Humana for care reminders, eligibility verification, and claims processing.
Integration with Molina Healthcare for eligibility and benefits verification and care reminders.
Integration with Florida Blue for care reminders and real-time eligibility verification.
Integration with Healthfirst New York for eligibility and care gap identification.