Availity Availity Payer List API
The Availity Payer List API from Availity — 1 operation(s) for availity payer list.
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OpenAPI Specification
openapi: 3.2.0
info:
title: Availity Payer List API
version: 1.0.5
x-custom-api-description: The Availity Payer List 1.0.5 API provides access to a comprehensive list of payers available through the Availity platform. It is designed to help healthcare applications dynamically retrieve and display payer information for use in various transactions.
description: 'Operations tagged Availity Payer List across 2 of this provider''s published API definitions: availity-payer-list-openapi.json, availity-payer-list-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: https://api.availity.com/v1
security:
- oauth2:
- hipaa
tags:
- name: Availity Payer List
paths:
/availity-payer-list:
get:
operationId: getCustomPayerList
parameters:
- description: 'The unique identifier used to communicate with the payer from Availity. example: "BCBSF:
'
in: query
name: payerId
required: false
schema:
type: string
- description: "The HIPAA code that identifies the transaction(s) supported by a payer \n270 ( Eligibility and Benefits Inquiry )\n276 ( Claim Status Inquiry )\n278I ( Health Care Services Inquiry )\n835 ( Claim Payment/Advice )\n837P ( Professional Claims )\n837PEncounter ( Professional Encounters )\n837PPredetermination ( Professional Pre-Determination )\n837I ( Facility Claims )\n837IEncounter ( Facility Encounter )\n837IPredetermination ( Institutional Pre-Determination )\n837D ( Dental Claims )\n837DEncounter ( Dental Encounter )\n837DPredetermination ( Dental Pre-Determination )\n277RFAI ( Attachment )\n275 ( Unsolicited Attachment )\n278N ( Notice of Admission )\nClaimStatusSummary ( Claim Status Summary )\nClaimStatusDetail ( Claim Status Detail )\nClaimStatusValueAdd ( Claim Status Plus Value Add )\n"
in: query
name: transactionType
required: false
schema:
type: array
items:
enum:
- '270'
- '276'
- 278I
- '835'
- 837P
- 837PEncounter
- 837PPredetermination
- 837I
- 837IEncounter
- 837IPredetermination
- 837D
- 837DEncounter
- 837DPredetermination
- 277RFAI
- '275'
- 278N
- ClaimStatusSummary
- ClaimStatusDetail
- ClaimStatusValueAdd
type: string
- description: "The method of submission for the transaction(s) supported by a payer. \n"
in: query
name: submissionMode
required: false
schema:
type: array
items:
enum:
- Portal
- Batch
- RealTime
- API
type: string
- description: Returns payers that do not require an Availity contract when availability=available. The opposite when availability=contract required
in: query
name: availability
schema:
type: string
enum:
- available
- contract required
- description: Filter by whether enrollment is required for any payer transaction
in: query
name: enrollmentRequired
schema:
type: boolean
responses:
default:
description: success
content:
application.json:
schema:
items:
$ref: '#/components/schemas/Payer'
type: array
summary: Query the list of available payers and transactions based on your Availity…
tags:
- Availity Payer List
servers:
- url: https://api.availity.com/v1
components:
schemas:
Payer:
properties:
displayName:
description: The name displayed on Availity Essentials for the payer.
example: FLORIDA BLUE
type: string
name:
description: The common name identifying the health plan.
example: FLORIDA BLUE (BCBS FLORIDA)
type: string
payerId:
description: The unique identifier used to communicate with the payer from Availity.
example: '14545'
type: string
processingRoutes:
description: A list of the routes available for communication from Availity to the payer.
properties:
additionalInfo:
description: Additional information about the transaction if any.
example: The 270 requires a GS02 value of LLX1210001. The 276 requires a GS02 value of LCX1210000.
type: string
availability:
description: Indicates whether the transaction is available to the organization under their current contract or requires an additional Availity contract. Note this refers to the Availity contract not the payer.
type: boolean
effectiveDate:
description: The date the transaction became available.
example: 2011-09-18T01:48:45.000+0000
type: string
enrollmentMode:
description: Indicates what type of enrollment is required with Availity(ex. Paper enrollment mode indicates additional paperwork must be submitted to the payer to complete the enrollment process).
enum:
- Manual Payer Submission
- Paperless
- Payer Portal Enrollment
- Paper
- Email Attachment
- Auto Complete
type: string
enrollmentRequired:
description: Indicates whether enrollment with Availity is required in order to submit the transaction.
type: boolean
gateway:
description: The designation if Availity is the gateway for this payer for this route.
example: Gateway
type: string
newTierNotice:
description: Notice of upcoming tier change if applicable.
example: New Tier Begins on 2022-12-01 - Comprehensive
type: string
passThroughRate:
description: The pass through rate for the route.
example: '0'
type: string
rebateTier:
description: The cost tier for the route.
enum:
- Base
- NonPar
- NonParPlus
- Other
- Par
- Comprehensive
- Standard
- Transitional
type: string
recentlyAdded:
description: The date the route was added.
example: 2022-11-18T01:48:45.000+0000
type: string
submissionMode:
description: Describes how the data is submitted to Availity(ex. Portal, Batch).
enum:
- Portal
- Batch
- RealTime
- API
type: string
transactionDescription:
description: Describes the type of transaction
enum:
- Eligibility and Benefits Inquiry
- Claim Status Inquiry
- Health Care Services Inquiry
- Claim Payment/Advice
- Professional Claims
- Professional Encounters
- Professional Pre-Determination
- Facility Claims
- Facility Encounter
- Institutional Pre-Determination
- Dental Claims
- Dental Encounter
- Dental Pre-Determination
- Attachment
- Unsolicited Attachment
- Notice of Admission
- Claim Status Summary
- Claim Status Detail
- Claim Status Plus Value Add
type: string
type: object
shortName:
description: A shortened name for the payer used in the file naming convention for batch transactions.
example: BCBS_OF_FL
type: string
type: object
securitySchemes:
oauth2:
type: oauth2
flows:
clientCredentials:
scopes:
healthcare-hipaa-transactions: Healthcare HIPAA Transactions
healthcare-hipaa-transactions-demo: Demo
healthcare-hipaa-transactions-highvolume: Healthcare HIPAA Transactions High Volume
healthcare-hipaa-transactions-highvolume-standard: Standard
healthcare-hipaa-transactions-highvolume-unlimited: Unlimited
healthcare-hipaa-transactions-standard: Standard
tokenUrl: https://api.availity.com/v1/token
x-refined-from:
- availity-payer-list-openapi.json
- availity-payer-list-openapi.yml