availity

aid: availity
url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/apis.yml
apis:
- aid: availity:availity-eligibility-benefits-api
  name: Availity Eligibility & Benefits API
  tags:
  - Benefits
  - EDI
  - Eligibility
  - Healthcare
  - X12 270/271
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/partner/documentation
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  - url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
    type: Documentation
  - url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-eligibility-openapi.yml
    type: OpenAPI
  - url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
    type: JSONSchema
  - type: NaftikoCapability
    url: capabilities/eligibility-eligibility.yaml
  description: 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 information. REST APIs connect provider systems to
    every major health plan nationwide for eligibility checks.
- aid: availity:availity-claims-status-api
  name: Availity Claim Status API
  tags:
  - Claims
  - Clearinghouse
  - EDI
  - Healthcare
  - X12 276/277
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/partner/documentation
    type: Documentation
  - url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  - url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-claim-status-openapi.yml
    type: OpenAPI
  - type: NaftikoCapability
    url: capabilities/claim-status-claim-status.yaml
  - type: NaftikoCapability
    url: capabilities/claim-status-enhanced-claim-status.yaml
  description: 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. REST APIs bridge provider billing systems and payers
    through the Availity clearinghouse network. Supports both standard 276/277 workflows and enhanced claim status with summary
    and detail search.
- aid: availity:availity-claim-attachments-api
  name: Availity Claim Attachments API
  tags:
  - Attachments
  - Claims
  - Clearinghouse
  - EDI
  - Healthcare
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  - url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-claim-attachments-openapi.yml
    type: OpenAPI
  - type: NaftikoCapability
    url: capabilities/claim-attachments-claim-attachments.yaml
  description: The Availity Claim Attachments API enables electronic submission of supporting documentation alongside healthcare
    claims. REST APIs support structured and unstructured attachment types for additional clinical information required by
    payers during claims adjudication.
- aid: availity:availity-service-reviews-api
  name: Availity Service Reviews (Prior Authorization) API
  tags:
  - EDI
  - Healthcare
  - Prior Authorization
  - Service Reviews
  - X12 278
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog/2025/3/4/service-reviews
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  - url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-service-reviews-openapi.yml
    type: OpenAPI
  - type: NaftikoCapability
    url: capabilities/service-reviews-auth-attachments.yaml
  - type: NaftikoCapability
    url: capabilities/service-reviews-is-auth-required.yaml
  - type: NaftikoCapability
    url: capabilities/service-reviews-service-reviews.yaml
  description: 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 manage authorization requests and responses with health
    plan payers through the Availity clearinghouse. Includes IsAuthRequired and Attachments add-on APIs.
- aid: availity:availity-hipaa-transactions-api
  name: Availity Healthcare HIPAA Transactions API
  tags:
  - Clearinghouse
  - EDI
  - Healthcare
  - HIPAA
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/portal/catalogue-products/healthcare-hipaa-transactions-1
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/portal/catalogue-products/healthcare-hipaa-transactions-1
    type: Documentation
  - url: https://developer.availity.com/blog/2025/3/25/hipaa-transactions
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: '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 receive X12 EDI transactions across payers including eligibility,
    claims, remittance, authorizations, and referrals. Quota: 100,000 calls per day, 100 calls per second rate limit.'
- aid: availity:availity-patient-cost-estimator-api
  name: Availity Patient Cost Estimator API
  tags:
  - Cost Estimation
  - Healthcare
  - Patient Financial Responsibility
  - Price Transparency
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/partner/documentation
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Patient Cost Estimator API enables healthcare providers and institutions to estimate service costs
    before delivery for both institutional and professional services. REST APIs support version 1.0.0 and 2.0.0 and include
    predetermination requests across all major health plan payers, helping meet price transparency requirements.
- aid: availity:availity-eb-value-adds-api
  name: Availity Eligibility & Benefits Value-Add APIs
  tags:
  - Care Reminders
  - EDI
  - Eligibility
  - Healthcare
  - Member ID Card
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Eligibility & Benefits Value-Add APIs provide supplementary data during eligibility transactions.
    The Care Reminders API retrieves real-time care gap information from multiple payers. The Member ID Card API retrieves
    digital member ID cards in PDF or PNG format during eligibility verification workflows.
- aid: availity:availity-payer-list-api
  name: Availity Payer List API
  tags:
  - Clearinghouse
  - Healthcare
  - Payer Network
  - Reference Data
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/partner/documentation
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: 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 transaction types including eligibility, claim status, prior
    authorization, and remittance across the nationwide Availity clearinghouse network.
- aid: availity:availity-configurations-api
  name: Availity Configurations API
  tags:
  - Configuration
  - Healthcare
  - Payer Requirements
  - Provider Validation
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/partner/documentation
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Configurations API (v1.0.0) provides provider details and payer-specific validation requirements.
    Returns configuration rules for enhanced claim status, prior authorization, and other transaction types so provider systems
    can validate submissions before sending to payers.
common:
- type: LinkedIn
  url: https://www.linkedin.com/company/availity
- url: https://www.availity.com
  type: Website
- url: https://developer.availity.com/
  type: Portal
- url: https://developer.availity.com/partner/documentation
  type: Documentation
- url: https://developer.availity.com/partner/gettingstarted
  type: GettingStarted
- url: https://developer.availity.com/blog/2025/3/25/availity-api-guide
  type: Documentation
- url: https://developer.availity.com/partner/contact-us
  type: Support
- url: https://www.availity.com/terms-of-use/
  type: TermsOfService
- url: https://www.availity.com/Privacy-Policy/
  type: PrivacyPolicy
- url: https://github.com/availity
  type: GitHubOrganization
- url: https://availity.github.io/sdk-js/
  type: SDK
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-eligibility-openapi.yml
  type: OpenAPI
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-claim-status-openapi.yml
  type: OpenAPI
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-claim-attachments-openapi.yml
  type: OpenAPI
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-service-reviews-openapi.yml
  type: OpenAPI
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  type: JSONSchema
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-ld/availity-eligibility-context.jsonld
  type: JSONLD
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-ld/availity-claim-context.jsonld
  type: JSONLD
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-ld/availity-service-context.jsonld
  type: JSONLD
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/rules/availity-spectral-rules.yml
  type: SpectralRules
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/vocabulary/availity-vocabulary.yaml
  type: Vocabulary
- type: Features
  data:
  - name: OAuth 2.0 Authentication
    description: Client credentials grant flow with 5-minute token expiration and HTTPS/TLS encryption for secure API access.
  - name: Real-Time EDI Transactions
    description: Processing over 8.8 million daily transactions and 11 billion annual healthcare transactions across all major
      health plans.
  - name: Nationwide Payer Network
    description: Access to every major health plan nationwide and over 1 million providers through the Availity clearinghouse.
  - name: Multi-Format Responses
    description: Returns JSON and XML representations including errors using HTTP response codes. Supports CSV, PDF, PNG,
      and XLS for specific endpoints.
  - name: Cursor-Based Pagination
    description: Collection resources support offset/limit pagination with limit range of 1-50 items per request with link
      relations.
  - name: Mock/Sandbox Testing
    description: Demo subscriptions support custom response selection via X-Api-Mock-Scenario-ID and X-Api-Mock-Response headers.
  - name: Rate Limiting
    description: Standard tier provides 100,000 calls per day and 100 calls per second for HIPAA transaction APIs.
  - name: ASC X12 EDI Standards
    description: Full support for HIPAA EDI version 005010 transactions including 270/271, 276/277, 278, and 835 transaction
      sets.
- type: UseCases
  data:
  - name: Real-Time Eligibility Verification
    description: Verify patient insurance coverage, co-pays, deductibles, and benefits in real time before scheduling or rendering
      services.
  - name: Claim Status Tracking
    description: Track submitted claims through adjudication, checking ACKNOWLEDGED, PENDING, PAID, DENIED, and ADJUSTED statuses.
  - name: Prior Authorization Management
    description: Submit and track prior authorization requests using X12 278 transactions to check if authorization is required
      before service delivery.
  - name: Patient Cost Estimation
    description: Estimate patient out-of-pocket costs before services are rendered to meet price transparency requirements
      and inform patients.
  - name: Electronic Claim Attachments
    description: Electronically attach clinical documentation to claims and authorizations, reducing manual faxing and accelerating
      adjudication.
  - name: Care Gap Identification
    description: Retrieve real-time care reminders during eligibility checks to identify preventive care gaps and coordinate
      outreach.
  - name: Digital Member ID Cards
    description: Retrieve member ID cards digitally during eligibility verification, reducing administrative burden and improving
      patient experience.
  - name: Multi-Payer Data Consolidation
    description: Connect to all major payers through a single clearinghouse API rather than managing individual payer connections.
- type: Integrations
  data:
  - name: EHR Systems
    description: Integrates with electronic health record systems to embed eligibility and claims workflows into clinical
      workflows.
  - name: Practice Management Systems
    description: Connects practice management software to payer networks for revenue cycle management and claims processing.
  - name: Revenue Cycle Management Platforms
    description: Integrates with RCM platforms to automate eligibility verification, claim submission, and payment reconciliation.
  - name: Blue Cross Blue Shield Plans
    description: Direct integration with BCBS plans nationwide for eligibility, claims, and prior authorization transactions.
  - name: Humana
    description: Integration with Humana for care reminders, eligibility verification, and claims processing.
  - name: Molina Healthcare
    description: Integration with Molina Healthcare for eligibility and benefits verification and care reminders.
  - name: Florida Blue
    description: Integration with Florida Blue for care reminders and real-time eligibility verification.
  - name: Healthfirst New York
    description: Integration with Healthfirst New York for eligibility and care gap identification.
maintainers:
- name: Kin Lane
  email: [email protected]
modified: '2026-05-19'
description: 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.